Results-oriented Claims Adjuster bringing hands-on service experience and exceptional leadership and communication skills. Background includes claims/compliance investigation, insurance fraud and quality-focused processes. My goal is to leverage my education and work experience while continuously being challenged. Personally, I have the determination to create win-win solutions for my clients and I know how to get the best from people by applying myself and having a can do attitude.
• Responsible for managing 100 to 120 lost time claims for one of the companies largest client contracts - 3M. Locations included administration facilities in addition to a half dozen high risk factories throughout the Midwest and Northern states of the USA.
• Demonstrate Ethics & Integrity by conducting workers compensation claims adjusting in a legal, ethical, fair and responsible manner.
• EDI reporting for each state requirements.
• Pursue subrogation were identified from start to finish.
• Work hand in hand with FMLA, STD, and LTD to ensure timely processes met with main goal of avoiding interruptions in employee pay.
• Prepare Monthly Status Reports documents for managers and shareholders detailing claim status,
exposure risks, and plan of action.
• Negotiate agreements to resolve disputes and pro se settlements.
• Maintain contact with claimants and attorneys to determine treatment status.
• Handling of incoming and outgoing calls from customers and other stakeholders about Workers Compensation processes.
• Reviewing and analyzing suspicious and potentially fraudulent insurance claims.
• Directing claims negotiations within allowable limit of $75,000.00 and supported successful litigations for advanced issues.
• Review new files to determine current status of injury claim and to develop plan of actions.
• Maintain SIR database in order to process all incoming mail including client updates, medical records, medical billing, and state specific requests.
• Review and process timely payment for medical visits once confirmed accurately billed.
• Chosen by CEO of company after three paneled interviews for position applied by 476 other applicants. Rated number 1 candidate of 476 highly qualified candidates.
• Sole Workers Comp Adjuster for entire 900 employee workforce with assistance from one internally employed Claims Assistant.
• Maintained 110+ caseload for primarily lost time workers compensation claims with a large majority including litigation.
• Processed and maintained leave of absence benefit records for approximately 900 employee workforce. This include four bi-state bridges located between NJ & PA, as well as, the subsidiary of DRPA train line which operates under the PATCO brand. Both DRPA had a police force for bridge operations and PATCO train line all of which I oversaw in regards to each employees workers comp, FMLA, MLOA, STD, and LTD benefits.
• Conducted new hire orientation with the goal of each newly hired employee understanding my departments goals and their benefits managed by my department.
• Chairman of the Incident Accident Investigation Committee which met on a monthly basis with the goal of identifying dangerous injury trends and implement processes and procedures to avoid reoccurrences where possible. Members included Chief of Police, Director of Procurement, Director of Risk Management Safety Director, General Counsel, as well as, PATCO General Manager, CEO’s Assistant, CFO, and Directors of each four bridges.
• Sole Workers Compensation Adjuster while performing FMLA, STD, and LTD Coordinator responsibilities due to staffing shortage. 70% of subsidiary PATCO was FMLA active.
• Maintained self insured annual budget for entire workers compensation department including FMLA, STD, and LTD.
• Fulfilled duties through written correspondence, personal visits, and verbal conversations with employees.
• Delivered targeted advice on issues such as applicable employment regulations, compensation strategies, and internal system upgrades to help update antiquated or ineffective approaches.
• Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
• Testified on behalf of agency as part of criminal and civic proceedings.
• Negotiated pro se settlement agreements to resolve disputes.
• Maintained suspicious claims database and implemented surveillance services where necessary.
• Visited each of the four bridge locations, administration locations, and PATCO train line locations to evaluate damage, identify injury trends, and to establish new procedures to avoid injury reoccurrences.
• Responsible for intake and closure of all property damage claims whether caused by internal employees, vendors, or public citizens using company assets like the bridges and train lines.
• Verified accuracy of medical coding, medical records, and court filings to maintain accuracy within internal databases.
• Responsible for processing medical payments in a timely manner.
• Pursued subrogation were identified from start to finish.
• Collected evidence to support contested claims in court.
• Directed claims negotiations within allowable limit of $50,000.00 and supported successful litigations for advanced issues.
• Established productive working relationships with public officials and law enforcement officers within the community and organization.
• Resolved complex, severe exposure claims using high service oriented file handling.
• Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
• Maintained contact with claimants, medical professionals, and attorneys to determine proper treatment plans with the goal of obtaining MMI in order for the employee to return to work with no restrictions.
• Member of the foreclosure team, as well as, team lead of the evictions team which I worked both positions simultaneously.
• Prepared approximately 10 judgments and writs daily within the foreclosure and eviction processes.
• Established productive working relationships with public officials and law enforcement officers.
• SCRA (military) search/investigation on each borrower including any and all potential heirs.
• PACER (bankruptcy) investigation searches on each borrower and any potential heirs and implementing case holds where necessary.
• Executed job requirements based upon company operation guidelines and review standards, while maintaining a self-set work plan and addressing shareholder concerns/complaints.
• Assisted counsel in preparing answers, providing documentation, and information for discovery requests.
• Maintained and updated organized client contact information to keep in touch with clients and provide updates on cases.
• Assisted in preparation of settlement proposals and agreements to help attorneys negotiate settlement in best interest of client.
• Managed scheduling of court calendars and deadlines to maintain smooth flow of firm operations.
• Wrote and filed pleadings with county specific courts as well as local Sheriff departments.
• Analyzed deeds of trust to verify grantor, grantee, trustee and loan amounts for executive leadership.
• Attended court hearings and depositions to take notes and document proceedings.
• Developed polished motions and briefs to support litigation processes and court proceedings.
• Conducted background investigations on defendants.
• Prepared court filings for mortgage foreclosure processes including 8-10 judgments and writ of executions daily.
• Edited and proofread legal documents to verify accuracy.
• Worked hand in hand with team of attorneys in order to deliver exceptional service to our clients and execute processes in a timely manner to secure and protect client assets.
• Assisted counsel in preparing answers, providing documentation, and information for discovery request.
• Worked with 67 county sheriff and prothonotary offices in the state of Pennsylvania including service processors to meet strict company deadlines.
• Maintained strict deadline calendars for entire office including attorney calendars.
• E-filing court pleadings in counties that offered e-filing services.
• Reviewing complaint, service of complaint, 10 day notices, in order to prepare judgments and writ of executions necessary to move along foreclosure process to the sheriff sale.
• Maintained up to date documentation and detailed information record keeping within client websites like Lenstar, LPS, Resware, as well as, internal company systems.
To align myself with a company that strives to stand above the rest and is dedicated to providing outstanding service to the client and/or community in which it serves.
Licensed in all lines of insurance through the State of Texas. Actively practiced and/or practicing in the following states: Minnesota, Wisconsin, Illinois, Indiana, Missouri, Kentucky, Iowa, New Jersey, and Pennsylvania.