Jamie Gonzales
Hamilton,NJ
Summary
Highly motivated and passionate Worker's Compensation Claims Specialist Supervisor. 12+ years experience in WC dealing with various states, including NJ, PA, NY, CT, DE and MD.
Overview
21
21
years of professional experience
Work History
Worker's Compensation Claims Specialist Supervisor
New Jersey Manufacturers Insurance
09.2024 - Current
- Oversaw daily operations of the territtory, ensuring smooth workflow and timely completion of tasks.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
- Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.
- Enhanced communication within the team by holding regular meetings and encouraging open dialogue among all members.
- Demonstrated commitment to the organization''s core values, leading by example and fostering a culture of excellence.
- Mentored junior staff members in their career development, sharing knowledge from years of experience in the field.
- Conducted performance evaluations for staff members, identifying areas of improvement and guiding professional development plans.
Senior Workers Compensation Claims Representative
New Jersey Manufacturers Insurance
11.2017 - 09.2024
- WC experience in multi-states- NJ, NY, PA, DE, CT and MD.
- Examines claims forms and other records to determine insurance coverage.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Resolved complex, severe exposure claims using high service oriented file handling.
- Directed claims negotiations within allowable limit and supported successful litigations for advanced issues.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Worked with private investigators and attorneys on preparation of evidence, witness statements and other documentation in preparation for trial.
- Maintained contact with claimants and attorneys to determine treatment status.
- Consistently reviews file for opportunities to resolve
Workers Compensation Claim Rep/Rep II
New Jersey Manufacturers Insurance
12.2012 - 11.2017
- Worked productively in fast-moving work environment to process large volumes of claims.
- Analyzed and addressed escalated claims to resolve issues quickly.
- Handles no time loss and time loss claims.
- Works with appropriate representative to negotiate and bring claim files to resolution.
- Assists in litigation of claims by participating in mediations and other hearings. Speaking with attorneys, medical professionals and Workers Compensation Judges.
- Ensures all legal documents are filed timely.
- Collaborated with internal departments and external vendors to achieve fast resolution of claims.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Updated claims system to track claim status and provide relevant information to other department.
- Prepared and presented detailed reports to management on claims issues to aid in decision making.
- Negotiated claim settlements with claimants and attorneys to resolve claims efficiently and fairly.
- Posted payments to accounts and maintained records.
Medical Billing- Worker's Compensation
New Jersey Manufacturers Insurance
12.2007 - 11.2012
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified client information by analyzing existing evidence on file.
- Posted payments to accounts and maintained records.
- Paid provider medical bills in appropriate time frames.
- Reviewed bills/medical records for relatedness, reasonableness, and necessity.
Central Files
New Jersey Manufacturers Insurance
11.2003 - 11.2007
Education
High School Diploma -
Nottingham High School
Hamilton, NJ2003
AIC, AIS, AINS -
The Institutes
OnlineSkills
- WC claims handling Expertise
- Territory/Staff Management
- Out of state licensing/continued education
- Training and mentoring
- Goal oriented
- Multitasking
- Team collaboration
- Complex Problem-solving
- Adaptability and flexibility
- Strategic planning
- Time management
- Systems and Software Expertise
- Effective communication
- Conflict resolution
- Telephone etiquette
- Attention to detail
- Organizational skills
- Client relationship building
- Staff development
- Relationship building
Timeline
Worker's Compensation Claims Specialist Supervisor
New Jersey Manufacturers Insurance
09.2024 - Current
Senior Workers Compensation Claims Representative
New Jersey Manufacturers Insurance
11.2017 - 09.2024
Workers Compensation Claim Rep/Rep II
New Jersey Manufacturers Insurance
12.2012 - 11.2017
Medical Billing- Worker's Compensation
New Jersey Manufacturers Insurance
12.2007 - 11.2012
Central Files
New Jersey Manufacturers Insurance
11.2003 - 11.2007
High School Diploma -
Nottingham High School
AIC, AIS, AINS -
The Institutes
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