Lori Ann Grammatis
Laurinburg,North Carolina
Summary
Results-driven Risk / Administrative Assistant bringing proven skills in administering various risk management programs. Effective in training team members to proactively identify and highlight potential risks. Dedicated to long-term risk management by building strong internal protocols and instilling culture of responsibility and attentiveness. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Seeking to maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
23
23
years of professional experience
Work History
Risk Management Analyst
CHARLOTTE COUNTY PUBLIC SCHOOLS
01.2019 - Current
- Ensures compliance with all aspects of Workers' Compliance reporting
- Manages the district's workers' compensation return to work program
- Acts as a liaison between injured workers' and the workers' compensation adjuster
- Works closely with district and school staff to reduce the frequency and severity of claims
- Advises Risk Management in the development of safety plans and identifies expected outcomes/results for the District
- Assists in investigation of accidents and make recommendations to prevent reoccurrence
- Assist with Student Accident reporting
- Perform other job-related functions as assigned.
Senior Claims Specialist
INTEGRITY EMPLOYEE LEASING
01.2011 - 12.2018
- Interact effectively with Client, adjusters, nurse case managers, investigators, attorneys and other personnel involved in claim process
- Supervisor in analyzing, planning, decision-making and problem-solving activities to offer client support
- Monitor legal and medical aspects of claims
- Document claim file activities in accurate and timely manner
- Resolve claim issues promptly and follow-up on outstanding issues
- Perform negotiation with insured and claimant to achieve claim settlements
- Communicate claim status to supervisor and customers on regular basis
- Gather information to share with outside agents for claim investigation if needed
- Work in compliance with state regulations
- Review work injury claims to determine if subrogation is an optional
- Review medical necessity, medical appointments, diagnostic testing, and supplies to see if necessary and/or appropriate
- Manage claim settlements within authority limits and document accordingly to policy
- Attend educational workshops on claim filings
- Perform data entry, filing, typing, word processing, record-keeping and letter writing.
Workers' Compensation Claims Manager
FIRST FINANCIAL
01.2002 - 01.2011
- Confirm coverage for first and third-party injury claims
- Hire, fire, train, discipline staff in the workers' compensation department
- Established guidelines on claim reporting procedures
- Assisted in the development in a software program to input and maintain claim tracking information
- Ensure accuracy of information collected and reported and guard against fraudulent claims
- Perform data entry, filing, typing, word processing, record-keeping and letter writing
- Review processed claims appealed by provider to determine accuracy
- Research plan details and apply adjustments as needed
- Contact provider and explain resolution of claim and also send letters as needed
- Update databases monthly to reflect claim cost
- Prepare statement for legal defense
- Investigate claims to determine legitimacy
- Discuss claim with all parties involved to make sure facts were documented and preserved
- Show empathy, give guidance and answer questions to provide great customer service.
Education
General
1983 Graduate of Scotland High School
Laurinburg, North CarolinaInsurance Claim Adjuster
Manatee Community College
Bradenton Florida06.2005
Skills
- Claims Handling and Filing
- Multi-Tasking
- CEU Insurance Regulations
- Microsoft Excel
- Word
- Outlook
- 10 Key
- Switchboard
- Claim Reviews
- Internal Audits
- Incident Investigations
- Employee Safety
- Exposure Assessment
- Data Analysis
Timeline
Risk Management Analyst
CHARLOTTE COUNTY PUBLIC SCHOOLS
01.2019 - Current
Senior Claims Specialist
INTEGRITY EMPLOYEE LEASING
01.2011 - 12.2018
Workers' Compensation Claims Manager
FIRST FINANCIAL
01.2002 - 01.2011
General
1983 Graduate of Scotland High School
Insurance Claim Adjuster
Manatee Community College
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