JAMES ROBICHEAUX
Covington
Summary
Results-driven Claims Specialist with over 20 years of experience in claims processing across various state and federal workers' compensation jurisdictions, specializing in Longshore and OCSLA claims. Proven ability to investigate and verify data for accurate claims settlements while meticulously documenting activities in platforms such as Origami, I Claims Expert, DAVE, ImageRight and Clara Analytics. Recognized for exceptional customer service skills, effective time management, and trend tracking capabilities, alongside a strong aptitude for troubleshooting and developing innovative solutions. Skilled communicator adept at fostering positive relationships and consistently exceeding performance goals within the insurance industry.
Overview
21
21
years of professional experience
Work History
Senior Workers' Compensation Claims Adjuster
Summit Holdings - GAIG
Baton Rouge, LA
02.2025 - Current
- Managed complex claims processes, ensuring compliance with regulations and company policies.
- Formulated and executed strategies to enhance claims processing efficiency.
- Established and maintained collaborative relationships with external partners, including healthcare providers and attorneys, to streamline claim processing.
- Led comprehensive investigations to ensure precise liability determination, facilitating equitable claim resolutions.
- Assisted claimants throughout entire submission process, guiding them regarding proper documentation requirements needed substantiate requests while also clarifying expectations concerning how long investigations might take before final decisions made about whether approve deny payouts proposed based findings obtained during case evaluations conducted teams assigned specialists like myself.
Claims Specialist
American Equity Underwriters
Mobile, AL/ Metairie, LA
01.2005 - 05.2024
- Maintained strict compliance with client and carrier guidelines applicable to Federal and state workers compensation claims.
- Interfaced with insured members to provide ongoing support and disclosure of investigation results.
- Coordinated final decisions, including fair settlements and denial of liability.
- Negotiated settlements and attended trials to provide insights and analysis.
- Improved claims handling processes by analyzing, tracking and troubleshooting root causes of previously managed claims.
- Calculated claims amounts and submitted paperwork for payment or review.
- Settled claims up to $5 million through skilled negotiations between involved parties.
Education
Bachelor of Science (B.S.) - Business Management
Southeastern Louisiana University
Hammond, Louisiana01.2002
High School - undefined
De La Salle High School
New Orleans, Louisiana05.1998
Skills
- Customer Service
- Team building
- Conflict Resolution
- Settlement coordination
- Claims Investigation
- Complex claims consulting
- Claims Analysis
- Accident investigations
Timeline
Senior Workers' Compensation Claims Adjuster
Summit Holdings - GAIG
02.2025 - Current
Claims Specialist
American Equity Underwriters
01.2005 - 05.2024
High School - undefined
De La Salle High School
Bachelor of Science (B.S.) - Business Management
Southeastern Louisiana University