JON MILLER
Sarasota,FL
Summary
Claims professional with deep experience in litigation claims and focus on claims evaluation and resolution. Adept at analyzing complex information, negotiating settlements, and ensuring compliance with regulations. Known for strong teamwork and adaptability and driving results in fast-paced environments. Skilled in customer communication, conflict resolution, and decision-making.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Legal Claims Adjuster
Davies US LLC
03.2021 - Current
- Responsible for completing claim file, which includes coverage verification, making preliminary determination of coverage and coverage research to address claim issues that arise to obtain the best outcome for the client.
- Evaluate claim detail, including Florida Statutes and case law, to determine compensability and total value of the claim
- Initiate investigation and assign defense counsel when appropriate
- Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments
- Monitor medical treatment in conjunction with assigned Nurse Case Manager
- Review, document, and approve medical bills for payment within three days of receipt
- Authorize appropriate medical services as outlined per Florida Statute 440.13
- Determine whether vocational rehabilitation services are needed for an employee to return to work
- Coordinate light duty availability and reasonable accommodations with medical providers and employers
- Maintain adequate reserves for life of claim utilizing reserve worksheets, ODG Guidelines, Worker’s Computation software and company reserving philosophy
- Attend client meetings as necessary, and maintain regular telephone contact to ensure client satisfaction
- Maintain diary and workflow requirements
- Maintain working knowledge of Worker’s Compensation Statutes and Rules, and their application
- Direct defense counsel in handling of litigation claims
- With defense input, make timely decisions regarding litigated issues
Lost Time Adjuster
Johns Eastern Company
12.2017 - 03.2021
- Determine compensability of newly acquired claims by using three-point contact and other investigative techniques
- Calculate and initiate indemnity payments in a timely manner and maintain diary for ongoing payments as required
- Make timely and proper completion of State filings of all required forms
- Monitor medical treatment in conjunction with Medical Management personnel where appropriate
- Promptly approve medical bills for payment
- Promptly authorize appropriate medical services
- Coordinate light duty availability with medical providers and employers
- Calculate and maintain adequate reserves for the life of the claim utilizing reserve worksheets and Johns Eastern reserving philosophy
- Evaluate and negotiate cases for settlement, as appropriate
Medical Only Adjuster
Johns Eastern Company
07.2017 - 12.2017
- Investigate claims by interviewing claimant, employer, witnesses, and physicians
- Determine compensability and total value of the claim
- Monitor medical treatment in conjunction with Medical Management personnel
- Promptly approve medical bills for payment
- Provide prompt authorization of medical services
- Coordinate light duty availability with medical providers and employers
- Maintain adequate reserves for life of claim
- Convey positive attitude and team spirit for optimum provision of services to customers
- Attend client meetings as necessary
- Determine subrogation potential and pursue recovery where applicable
- Maintain acceptable claim closure ratio
Customer Service Staff
PUBLIX INC
04.2016 - 07.2017
- Supervised delegated responsibilities from Management including coordinating the front end
- This involves managing how many cashiers are open, sending employees home/to break, and ensuring every customer on the front end is satisfied
- Developed strong communication skills by dealing with customers’ problems and determining refund requests
- Regularly handled large-dollar money transactions including money orders, Western Union, and check cashing
Education
Bachelor of Business Administration - Finance, Risk Management & Insurance
Florida State University
Tallahassee, FL05.2017
Skills
- Effective organizational skills
- Strategic problem-solving
- Detail-oriented data analysis
- Strong verbal and written communication
- Computer literacy
- Skilled in MS Office applications
Certification
Florida All-Lines Adjuster License
Timeline
Legal Claims Adjuster
Davies US LLC
03.2021 - Current
Lost Time Adjuster
Johns Eastern Company
12.2017 - 03.2021
Medical Only Adjuster
Johns Eastern Company
07.2017 - 12.2017
Customer Service Staff
PUBLIX INC
04.2016 - 07.2017
Bachelor of Business Administration - Finance, Risk Management & Insurance
Florida State University
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