Kelly Vice
Charlotte,NC
Summary
Accomplished Claims Examiner with a proven track record at Sedgwick CMS, adept in handling sensitive information and reducing claim processing times. Excelled in negotiating settlements and mentoring junior adjusters, showcasing strong decision-making and customer relationship skills. Developed efficient workflow strategies, significantly enhancing operational efficiency.
Overview
31
31
years of professional experience
Work History
Claims Examiner
Sedgwick CMS
08.2021 - Current
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Handles a litigation desk for the state of New Jersey.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Dedicated examiner for a high profile , global client. Jurisdiction: New Jersey
- Negotiated settlements with claimants'' attorneys when needed, achieving favorable outcomes for both parties while minimizing costs.
- Served as a mentor to junior adjusters sharing expertise and providing guidance on best practices within the field of claims examination.
- Directed claims negotiations within allowable limit of $25,000.00 and supported successful litigations for advanced issues.
- Completes thorough investigation of questionable claims.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Completed Carrier reporting when necessary.
Sr. Resolution Manager
Gallagher Bassett Services
10.2009 - 08.2021
- Handled WC Indemnity claims for multiple employers over the years for the Jurisdictions of MD, DC,VA
- Over the years handled such accounts such as : Coca Cola Consolidated, Penske, Uhaul , Sysco, ATD, Southeastern Freight Lines, Airgas, Nursing homes, Gordon Foods, Dunbar Armored and Live Nation Worldwide, just to name a very few.
- Worked closely with client, FCM'S and attorneys.
Claims Administrator
Cowan Systems
02.2008 - 10.2009
- Handled and overseer of all WC, cargo and auto claims .
- Corresponded with defense counsel, insurance adjusters on workers compensation , auto liability and litigated claim with discovery. Jurisdiction: Ohio
- Stayed updated with industry regulations, ensuring compliance in all claim-handling procedures.
Risk Manager
Two Farms Inc
06.1994 - 02.2008
- Handled 4 different loss lines/State of MD : Property Damage (prepared the suits and attended court), Workers Compensation claims, Auto and General Liability
- Taught companywide Safety Classes-Baltimore/Eastern Shore
- Developed short-term goals and long-term strategic plans to improve risk control and mitigation.
- Developed strong relationships with internal stakeholders, promoting a culture of risk awareness and accountability.
- Developed our first ever light duty program. (success)
- Prepared Interrogatories for General Liability claims. Hands on attended Workers Compensation hearings to testify if needed, settlement conferences and mediations.
Education
No Degree - Journalism/Minor in Criminal Justice
Virginia Union University
Richmond, VaHigh School Diploma -
Western Senior High School
Baltimore, Md 06-1991
Skills
- Claim reviews
- Self motivation
- Microsoft office, Word
- Assertiveness
- Phone and email etiquette
Strong claims handling
- Decision-making
- Positive attitude
- Customer service and support
- Adaptability and flexibility
- Very strong customer relationships
- Attendance -Strong, no call outs, advanced planned time off
Accomplishments
- Performance Evaluations: Exceeds Expectations 97%
- High claim closure rates /2024: 111%
Dale Carnegie Leadership 3 month course completed in 2008
AIC 33 class completion in 2005. Zurich Insurance
Risk Manager Certification, Minnesota, 2004
GB Branch Employee of the year " I am Gallagher" globe/2011
Our Gallagher Bassett Branch of the Year /2017
Top Closures/Litigated Files/2021-2024 files EE Recipient, 12-2024
Audit Scores/Exceeds 90%, some 100% file audits-2024
Client and Companywide compliments
Timeline
Claims Examiner
Sedgwick CMS
08.2021 - Current
Sr. Resolution Manager
Gallagher Bassett Services
10.2009 - 08.2021
Claims Administrator
Cowan Systems
02.2008 - 10.2009
Risk Manager
Two Farms Inc
06.1994 - 02.2008
No Degree - Journalism/Minor in Criminal Justice
Virginia Union University
High School Diploma -
Western Senior High School
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