Kelly Duffy
Elwyn
Kennett Square,Pennsylvania
8
years of professional experience
Results-driven professional prepared for claims management roles, bringing in-depth experience in claims processing and risk evaluation. Noted for collaborative team leadership. Valued for precision in claims analysis and adaptability to changing industry standards.
Work History
CLAIMS MANAGER
3 Years 2 Months- Determined appropriate claim settlement authority and delegated responsibilities to claims representatives for Workers’ Compensation, Commercial Auto and General Liability Claims.
- Oversaw operation of claims production to verify correct protocol adherence. Conducted quarterly claim file reviews.
- Applied knowledge of relevant laws, regulations, policies, procedures, and guidelines to evaluate claims accurately and train staff.
- Utilized analytics, metrics and benchmarking through multiple sources to evaluate loss trends and cost of risk.
- Performed extensive research into individual cases prior to making decisions regarding liability or damages awards.
- Managed vendor relationships by overseeing the performance of third-party service providers involved in the claims process.
- Created detailed reports on claims processing performance for senior management review.
WORKERS' COMPENSATION CLAIMS MANAGER
1 Year 5 Months- Collaborate with departmental leaders to establish organizational goals, strategic plans and objectives.
- Support legal staff in responding to inquiries from internal and external stakeholders.
- Update case management system with notes, data and reports.
- Create settlement packages in best interest of Elwyn after collecting and analyzing respective data.
- Summarized and recorded each legal action filed to reflect current status of litigation cases or disposition of cases in active litigation.
CLAIMS EXAMINER
2 Years 2 Months- Resolve complex, severe exposure claims, using high service oriented file handling adhering to carrier guidelines.
- Educate clients on Pennsylvania, Delaware and New Jersey workers compensation jurisdictional laws.
- Work with defense attorney to create a mutual action plan to efficiently resolve claims within authority level.
- Review high dollar claims with carrier and client to breakdown areas of concern in an effort to limit exposure on file.
- Work with claimants to explain claim handing process and settlement valuations to provide a fair and reasonable settlement for all parties.
CLAIMS REPRESENTATIVE (IAP)
1 Year 2 Months- Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- Evaluate claim exposure and adjust reserves (or provide reserve recommendations) to ensure that reserve activities are consistent with corporate policies and carrier guidelines.
- Enter award payments ordered by workers compensation Judge ensuring timely payment and detailed documentation on award expiration.
- Manage high dollar catastrophic claims for public entities by building and adhering to detailed action plans.
Education
Bachelor of Business Administration - Risk Management and Insurance
- Extracurricular Activities
- Gamma Iota Sigma (Risk and Insurance Fraternity)
- Delta Zeta (ΔZ)
Skills
Experience handling litigated
catastrophic CA
NJ and PA Workers' Compensation Claims.
Experience handling self-insured P&C claims including General Liability and Commercial Auto.
Timeline
CLAIMS MANAGER
Elwyn
06.2023 - CurrentRead More
WORKERS' COMPENSATION CLAIMS MANAGER
Elwyn
01.2022 - 06.2023Read More
CLAIMS EXAMINER
Sedgwick
11.2019 - 01.2022Read More
CLAIMS REPRESENTATIVE (IAP)
Sedgwick
09.2018 - 11.2019Read More
Temple University
Bachelor of Business Administration from Risk Management and Insurance
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