Jessica C Miller
Ankeny,IA
Summary
Dynamic Claims Specialist with extensive experience, excelling in claims analysis and negotiation. Proven track record in resolving complex workers' compensation claims while delivering exceptional customer service. Skilled in fraud detection and conflict resolution, ensuring compliance and facilitating timely resolutions for all stakeholders involved.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Claims Specialist III, Workers' Compensation
United Fire Group
12.2014 - Current
- Investigate complex claims to determine coverage and compensability in multiple jurisdictions, including Iowa, Colorado, New Jersey, Nebraska, and Illinois.
- Collaborate with nurse case managers and vocational specialists to facilitate return to work.
- Obtain and review wage documentation to determine rates and benefits due.
- Maintain detailed records of all claim activities, including notes about conversations with claimants or representatives.
- Negotiate and mediate litigated and non-litigated claims to bring them to resolution.
- Research medical records to evaluate claim validity and verify the existence of pre-existing conditions.
- Facilitate communication between claimants, providers, attorneys, adjusters, employers, and other parties involved in a claim.
- Monitor reserve accuracy and make necessary adjustments.
- Identify and pursue subrogation opportunities to recover costs.
- Analyze claim information to identify potential fraud or discrepancies.
Claims Adjuster II, Workers' Compensation
EMC Insurance Company
10.2012 - 12.2014
- Managed workers' compensation claims across Iowa, Minnesota, and Nebraska involving medical and indemnity payments.
- Investigated claims compensability by analyzing medical records and loss facts.
- Addressed subrogation and legal issues as necessary to resolve claims efficiently.
- Set and maintained accurate reserves aligned with loss assessments.
- Handled litigated files, attended mediations, negotiated settlements, and submitted required paperwork.
- Collaborated closely with defense attorneys to expedite closure of litigated files through mediation or hearings.
- Partnered with nurse case managers on complex medical cases to ensure appropriate care and facilitate return to work.
- Delivered exceptional customer service to employers, employees, medical experts, agents, and stakeholders in claims process.
Claims Specialist II, Workers' Compensation
Nationwide Agribusiness
11.2009 - 09.2012
- Managed medium to large loss workers' compensation claims across multiple jurisdictions including Iowa, Minnesota, and California.
- Oversaw reserve management to align with losses and communicated claim status to customers.
- Handled litigated files, attending mediations and negotiating settlements effectively.
- Collaborated with defense attorneys to resolve litigated cases through mediation or hearings.
- Delivered exceptional customer service to employers, agents, and injured workers.
- Coordinated appropriate care for injured workers to facilitate timely return to employment.
Claims Analyst, Long Term Disability
Principal Financial Group
07.2002 - 11.2009
- Reviewed and analyzed disability claims to ensure compliance with policies and regulations.
- Communicated decisions to customers, employers, employees, and physicians regarding claim status.
Education
B.A. - Business Administration
Grand View College
Des Moines, IA12.2000
Skills
- Claims analysis/management
- Medical record review
- Compliance assessment
- Negotiation strategies
- Fraud detection
- Conflict resolution
- Communication skills
- Regulatory knowledge
- Customer service excellence
- Settlement coordination
Certification
- Workers' Compensation Law Associate
- Workers' Compensation Law Specialist
- Workers' Recovery Professional Certification
Timeline
Claims Specialist III, Workers' Compensation
United Fire Group
12.2014 - Current
Claims Adjuster II, Workers' Compensation
EMC Insurance Company
10.2012 - 12.2014
Claims Specialist II, Workers' Compensation
Nationwide Agribusiness
11.2009 - 09.2012
Claims Analyst, Long Term Disability
Principal Financial Group
07.2002 - 11.2009
B.A. - Business Administration
Grand View College
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