Jessica R. Lord-Tovar
Long Beach,CA
Summary
Skilled claims professional adept at managing California workers' compensation claims for major national insurance providers, self-insured entities, and TPAs.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Team Lead
Sedgwick
West Hills, California
03.2025 - 05.2025
- Supervised claims processing team ensuring compliance with industry regulations.
- Reviewed complex claims for accuracy and adherence to guidelines.
- Performed quality assurance reviews on claims submitted by staff to ensure compliance with company standards.
Claims Trainer
CIGA – California insurance Guarantee Association
Glendale, CA
01.2019 - 08.2024
- Facilitated training sessions emphasizing practical applications of workers' compensation laws and statutes to enhance adjuster competency.
- Developed and implemented a comprehensive training curriculum for entry-level claims adjusters.
- Assessed the effectiveness of the training programs and made continuous improvements based on feedback and performance assessments.
- Continuously monitored industry trends, regulatory updates, and best practices in workers' compensation to ensure training content is relevant, accurate, and aligned with current standards.
- Collaborated with management and other stakeholders to identify training needs and address skill gaps within the claims team.
- Created instructional materials, including presentations, SOPs, and job aids, to effectively support the training program.
- Mentored and supported new adjusters during their transition, providing guidance and addressing questions to foster confidence and proficiency.
Program Manager
CIGA – California insurance Guarantee Association
Glendale, CA
01.2012 - 01.2019
- Established goals and objectives for TPA locations aligned with Claims Department priorities.
- Developed and implemented transition plan for new TPA partners, creating training workshops and job aids for onboarding Claims teams to CIGA’s policies and procedures.
- Developed and delivered training to the TPA Claims staff to ensure adherence to CIGA’s policies and procedures.
- Conducted quarterly in-person visits to TPA locations to provide training and communicate closing and audit metrics results.
- Oversaw the overall performance of our TPA vendors, ensuring compliance to CIGA’s guidelines.
- Evaluated settlement and reserve adjustment requests beyond TPA authority limits and provided feedback.
- Developed and implemented oversight programs to ensure audit results met or exceeded CIGA’s audit benchmarks.
- Provided expertise on claims matters related to Insurance Code Section 1063, CIGA defenses and complex/catastrophic medical claims.
Claims Supervisor
CIGA – California insurance Guarantee Association
Glendale, CA
01.2011 - 01.2012
Claims Supervisor
Octagon
Van Nuys, CA
01.2006 - 01.2009
Claims Supervisor; Claims Manager
Gates McDonald
Los Angeles
01.1999 - 01.2006
Claims Adjuster; Claims Team Manager
Liberty Mutual/Helmsman Management Services
Los Angeles
01.1999 - 01.2006
Education
Bachelor’s Degree -
California State University, Northridge
Skills
- Microsoft Office Suite
Certification
Workers Compensation Self Insurance Claims Administrators Certificate, 05/01/91
Affiliations
Volunteer - Rancho Los Cerritos, Long Beach, CA
Timeline
Team Lead
Sedgwick
03.2025 - 05.2025
Claims Trainer
CIGA – California insurance Guarantee Association
01.2019 - 08.2024
Program Manager
CIGA – California insurance Guarantee Association
01.2012 - 01.2019
Claims Supervisor
CIGA – California insurance Guarantee Association
01.2011 - 01.2012
Claims Supervisor
Octagon
01.2006 - 01.2009
Claims Supervisor; Claims Manager
Gates McDonald
01.1999 - 01.2006
Claims Adjuster; Claims Team Manager
Liberty Mutual/Helmsman Management Services
01.1999 - 01.2006
Bachelor’s Degree -
California State University, Northridge