Jessica M. Gardner
Summary
Professional with deep expertise in claims management, prepared to excel in this role. Known for strong analytical skills, effective problem-solving, and thorough understanding of insurance policies and regulations. Team-oriented and results-driven, flexible in adapting to changing priorities. Recognized for exceptional communication, negotiation abilities, and focus on delivering high-quality outcomes.
Overview
17
17
years of professional experience
Work History
Claims Consultant
WC – CCMSI
12.2023 - Current
- Handle claims for self-insured and TPA accounts
- Ensuring 3-point contacts are made without 24 hours
- If contact attempts are unsuccessful, ensure additional attempts are made until successful contact is made
- Manage medical treatment per jurisdictional requirements
- Work with attorneys and claimants to settle claims
- Negotiate and issue settlement checks within jurisdiction specific timeframes
- Work with clients and carriers to obtain appropriate settlement authority
- Attend mediations, as needed
- Ensure claims are being reported to carriers when retention limits are met
- Calculate average weekly wage and temporary total disability rates
- Issue out temporary total disability or temporary partial disability benefits on accepted claims
- Calculate PPD/PPI, as required under jurisdictional requirements and issue benefits are required
- Ensure state required forms are being submitted timely and accurately
- Communicate with clients, providers, and claimants via fax, email, and phone to answer questions, obtain statements, provide authorization, and resolve issues
- Reserve claims within client specific timeframes
- Ensure reserves remain appropriate for the life of the claim to ensure payments can be issued as necessary
- This may require obtaining authority from clients or carriers prior to increasing reserves
- Issue denials on claims that are deemed non-compensable or issue coverage denials
- Communicate those denials with our clients, the claimant, and medical providers
- Maintain all current license
- Communicate with clients, providers, and claimants via fax, email, and phone to answer questions, obtain statements, provide authorization, and resolve issues
- Ensure claims handling meets the Assigned Risk and Unbundled program requirements
- Currently handle claims in Minnesota and Wisconsin
- Present claims at in-person and online claim reviews
- Assist with training new employees, as needed
- Submit reimbursement requests to the appropriate reinsurance carrier
- Provide updates, per claims handling guidelines to the appropriate reinsurance carrier
Senior Account Claims Representative – WC
PMA Companies
03.2021 - 12.2023
- Handled litigated, complex lost time and medical only claims for the Assigned Risk Program and the Unbundled Team
- Ensuring 3-point contacts are made without 24 hours
- If contact attempts are unsuccessful, ensure second attempt made within 24 hours of claims receipt
- Manage medical treatment per jurisdictional requirements
- Work with attorneys and claimants to settle claims
- Negotiate and issue settlement checks
- Complex Loss reports on any claim over $250,000, that needs settlement approval, or as requested by Program Managers
- Calculate average weekly wage and temporary total disability rates
- Issue out temporary total disability or temporary partial disability benefits on accepted claims
- Calculate PPD/PPI, as required under jurisdictional requirements and issue benefits are required
- Complete state requires forms and ensure submitted on a timely basis
- Communicate with clients, providers, and claimants via fax, email, and phone to answer questions, obtain statements, provide authorization, and resolve issues
- Reserve claims within company mandated timeframes
- Ensure reserves remain appropriate for the life of the claim to ensure payments can be issued as necessary
- This may require obtaining authority from clients prior to increasing reserves
- Issue denials on claims that are deemed non-compensable or issue coverage denials
- Communicate those denials with our clients, the claimant, and medical providers
- Obtained Georgia licensure
- Started the Associates in Risk Management program and have completed 2 of the 4 classes
- Completed the Associates in Claims program through The Institutes
- Maintain all current licensure
- Communicate with clients, providers, and claimants via fax, email, and phone to answer questions, obtain statements, provide authorization, and resolve issues
- Ensure claims handling meets the Assigned Risk and Unbundled program requirements
- Handled claim in Massachusetts, Wisconsin, Minnesota, Iowa, Michigan, Missouri, Kansas, Illinois, Indiana, Vermont, and Georgia
- Present claims at in-person and online claim reviews
Senior Claims Examiner – WC
Sedgwick Claims Management Service
03.2020 - 03.2021
- Currently handed complex lost time and medical only claims
- Manage claims with active litigation
- Pay out indemnity benefits on accepted workers compensation claims
- Calculate out average weekly wages and temporary total disability rates
- Negotiate and issue settlement checks, as appropriate
- Currently manage new and existing claims that are open for active medical treatment and lost time
- Work with attorneys and clients to settle workers compensation claims
- Obtain and grant authority, as necessary
- Communicate with clients, providers, and claimants via fax, email, and phone to answer questions, obtain statements, provide authorization, and resolve issues
- Issue medical and indemnity payments within the state mandated timelines
- Ensure formwork is filed within those same timeframes
- Issue denials on claims that are deemed non-compensable or issue coverage denials
- Communicate those denials with our clients, the claimant, and medical providers
- Reserve claims within company mandated timeframes
- Ensure reserves remain appropriate for the life of the claim to ensure payments can be issued as necessary
- This may require obtaining authority from clients prior to increasing reserves
- Work with medical providers to resolve billing issues on claims
- Many of my current job duties overlap with my job duties from my position with Liberty Mutual
- Obtained my Indiana and Minnesota adjuster license
- I am currently handling complex worker’s compensation
Sr. WC Claims Technician - WC
Liberty Mutual Commercial Insurance
08.2008 - 03.2020
- Employed with Liberty Mutual since March 2008
- Medical only/ MMU worker’s compensation adjuster working out of the Wausau, WI office
- Previously worked remotely for the Syracuse, NY office handling Connecticut, New Hampshire, New York, Rhode Island, Maine, Massachusetts, and Vermont
- Currently manage pension claims that are post litigation and have stable medical, ongoing indemnity payments, or are open for subrogation purposes only and medical only claims
- Currently handle workers’ compensation claims for Indiana, Illinois, Minnesota, South Dakota, Missouri, Kansas, Iowa, Michigan, and Nebraska
- I also have knowledge of Pennsylvania, Virginia, Maryland, District of Columbia, Alabama, Mississippi, New Jersey, Kentucky, Pennsylvania, Delaware, and any claim that has a loss state of Ohio
- My current job entails setting up a new claim, making contact with insured’s, employee’s, and medical providers to verify claim information, handling basic and non-complex investigation, basic coverage denials, and handling the medical aspects of the claim until the claimant is released from care along with making sure all medical bills have been received and paid on these claims
- Handle phone calls from providers, claimants, and insured’s to answering any questions they may have
- I’m a licensed adjuster in West Virginia – company adjuster, Kentucky – property and casualty adjuster license, Connecticut – all lines adjuster license (resident state license), Florida – workers’ compensation adjuster license, South Carolina – workers’ compensation adjuster license, North Carolina – company/independent adjuster, New Hampshire – workers’ compensation adjuster license, Rhode Island – workers’ compensation adjuster license, Vermont – workers’ compensation adjuster license and Delaware – workers’ compensation adjuster license
- I am also registered with the Georgia workers’ compensation commission
- Won the Best Work award for training I conducted with the Syracuse medical only adjusters on the Legacy RCG systems in June 2017
- Identify areas of improvement and follow/work with other departments to improve those processes
- Attend a team huddle every morning to discuss updates and any issues
Education
Associates in Risk Management -
The Institutes
02.2025
Associates in Claims -
The Institutes
01.2023
Business Administration -
Upper Iowa University
01.2015
Bachelors of Psychology -
Upper Iowa University
01.2015
Skills
- Claims analysis
- Investigation techniques
- Policy interpretation
- Claims investigation
- Teamwork and collaboration
- Customer service
- Problem-solving
- Attention to detail
- Computer skills
- Critical thinking
- Effective communication
- Decision-making
Timeline
Claims Consultant
WC – CCMSI
12.2023 - Current
Senior Account Claims Representative – WC
PMA Companies
03.2021 - 12.2023
Senior Claims Examiner – WC
Sedgwick Claims Management Service
03.2020 - 03.2021
Sr. WC Claims Technician - WC
Liberty Mutual Commercial Insurance
08.2008 - 03.2020
Associates in Claims -
The Institutes
Business Administration -
Upper Iowa University
Bachelors of Psychology -
Upper Iowa University
Associates in Risk Management -
The Institutes
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