Keith Graham

Workers' Compensation Claims Representative

Paragon Casino Resort

01.2015 - 11.2025

Processed workers' compensation claims efficiently to ensure timely resolution with the Risk Manager and TPA.
Investigated claim details by collaborating with the Risk Manager, Security Management, with Surveillance and the appropriate department with medical to gather necessary documentation needed for a work compensation claim.
Reviewed the incident report, voluntary statements and surveillance coverage to assess claim validity and coverage eligibility.
Maintained accurate and organized claim files to support effective case management and audits.
Communicated claim status updates clearly with Risk Manager and TPA addressing concerns and providing reassurance.
Evaluated medical treatment plans for appropriateness and compliance with regulatory standards.
Coordinated with legal teams to address disputes and ensure compliance with workers' compensation laws.
Ensured compliance with state regulations while processing and documenting claims.
Assisted in resolving complex claims by conducting thorough investigations and assessments.
Participated in team meetings to discuss claim strategies and share insights on best practices.
Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Researched claims and incident information to deliver solutions and resolve problems.
Analyzed information gathered by investigation and reported findings and recommendations.
Conducted comprehensive interviews of witnesses and claimants to gather facts and information, then shared with the Risk Manager and TPA.
Reviewed questionable claims by conducting Risk Manager, Surveillance, Security Management, TPA and claimant interviews to correct omissions and errors.
Identified suspicious losses and contacted Risk Manager Surveillance, Security Management and TPA for investigative assistance.
Maintained contact with claimants, Risk Management and TPA to determine treatment status.
Documented information gathered in field and uploaded data to company database for efficient processing using the File Handler software.
Evaluated original investigation reports and documents to resolve secondary concerns.
Directed and coordinated various investigations conducted by field a private investigation team. Prepared summary reports, quarterly reports, financial reports including the Reserves set forth by the TPA for the Risk Manager, Human Resources and the Accounting Department. Meet with the injured associate, relay and sign all appropriate work compensation documentation and explain how their claim works. Send all authorizations to choice of medical provider. Receive and process requesting treatment forms, process billing, mileage forms, calculating TTD rates, setting appointments, assisting medical providers and managing a claim from open to close.