LAURA SERATT
LANSING,MI
Summary
Workers Compensation Medical Claims Representative with excellent planning and problem solving abilities. Offering 20 years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.
Overview
21
21
years of professional experience
Work History
Claims Representative
Accident Fund Insurance
Lansing, MI
06.2021 - Current
- Examined reports, accounts and evidence to determine integrity and accuracy of information.
- Interviewed policyholders to verify information and obtain additional details.
- Checked level and type of coverage and evaluated contracts.
- Followed up with customers on unresolved issues.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Verified client information by analyzing existing evidence on file.
- Handle high case load with 160 files and high phone call volumes.
Claims Representative II
EMC Insurance Companies
Lansing, MI
01.2014 - 06.2021
- Investigations, negotiations and litigation for complex compensation claims handling through mediation, statutes review and trial. Current claim caseload is over 100.
- Responsible for review and analysis of insurance policy terms, conditions and exclusions to determine loss coverage.
- Established and maintained excellent services to independent agents, injured workers, attorneys, physicians, policy holders and contractors to effectively process claims management.
- Reviewed documentation and accounts to gain knowledge of full picture.
- Verified details with policyholders and requested additional information for appropriate reserves.
- Ability to prioritize and organize skills and tasks to efficiently accomplish service goals.
- Mediate prior to arbitration and appeals.
- Assist new claims adjusters with training and team goals.
Claims Consultant
Coverys Insurance Services
East Lansing, MI
01.2013 - 01.2014
- Managed claims information for health facilities. Calculation of wage loss compensation benefits and impairment ratings for injured workers in compliance with South Dakota and estimated financial exposure.
- Established and maintained relationships with consumers which included injured workers, attorneys, physicians, policy holders and contractors and quickly gained their confidence. Worked caseload of over 120 claims.
- Performed audits of work flow and established efficient procedures that increased work efficiency.
Compensation Claims Representative
Auto-Owners Insurance Company
Lansing, MI
01.2003 - 01.2012
- Managed caseload of 130+ claims for Michigan and Pennsylvania while responding to call count of 60+ calls per day.
- Established and maintained relationships with injured workers, attorneys, physicians, policy holders and contractors that continue to be maintained and aid with production of high quality results.
- Create timely reports to inform supervisors regarding high valued claims and life expectancy. Settlement authority was $100,000.
- Reported claims to Medicare per Federal Guidelines.
- Attended legal seminars that aided with increased performance with complex claims.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Delivered exceptional customer service to all clients by effectively communicating information and actively listening to concerns
- Explained loss coverage, assisted policyholders with itemizing financial damages and coordinated medical care.
Education
Bachelor of Arts - Criminal Justice, Business Administration/Community Service
Siena Heights University
05.2001
Skills
- Problem Resolution
- Documentation And Reporting
- Office Administration
- Professional Demeanor
- Management Skills
- Application Review
- Loss Protection
- Criminal Justice Knowledge
- Information Services
- Value-Added Informational Services
- Invoicing
- Online Training Services
- National Crime Information Center (Ncic)
Professional Designations
- Associate in Claims Designation (AIC)
- Associate in Insurance Services Designation (AIS)
- Associate in Insurance (AINS)
- Workers Compensation Claims Law Specialist (WCLS)
Timeline
Claims Representative
Accident Fund Insurance
06.2021 - Current
Claims Representative II
EMC Insurance Companies
01.2014 - 06.2021
Claims Consultant
Coverys Insurance Services
01.2013 - 01.2014
Compensation Claims Representative
Auto-Owners Insurance Company
01.2003 - 01.2012
Bachelor of Arts - Criminal Justice, Business Administration/Community Service
Siena Heights University
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