LYN K. SCOTT
Carson,CA
Summary
Experienced in managing complex workers' compensation claims and driving early resolution strategies, with a strong focus on innovation management and collaboration. Skilled in navigating high-stakes medical and legal environments to deliver optimal outcomes. Seeking to leverage expertise in a new role as a Workers' Compensation Specialist to enhance team success and client satisfaction.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Senior Workers’ Compensation Adjuster
PRG Staffing
10.2025 - Current
- Managed complex workers' compensation claims from initial reporting to resolution.
- Conducted thorough investigations to determine claim validity and ensure compliance with regulations.
- Collaborated with medical professionals to evaluate treatment plans and establish appropriate benefits.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
Claims Specialist
American Equity Underwriters
11.2020 - 10.2024
- Handled workers' compensation claims under the U.S. Longshore & Harbor Workers' Compensation Act (USL&H) and California State Jurisdiction.
- Reviewed incoming documentation for completeness prior to processing a claim.
- Provided customer service to policyholders and claimants by answering their questions, resolving disputes, and explaining coverage details.
- Analyzed claims to determine extent of company's liability and made approval or denial decisions in accordance with policy provisions.
- Evaluated claim values and setting reserves for exposure and probable outcome.
- Analyzed claims data to determine appropriate resolution of cases according to company policies and procedures.
- Collaborated with other departments such as underwriting, sales, accounting, and legal when necessary.
Senior Workers' Compensation Examiner
Keenan & Associates
10.2016 - 10.2020
- Administering and Managing claims for high profile healthcare client
- Completing Client File Reviews and Presentations
- Managing Medical Treatment and weaning of opioids/pain medications
- Maintaining closing and settlement ratio
Senior Workers' Compensation Representative
ESIS/ACE Group
03.2015 - 10.2016
- Managing high exposure claims for high profile client
- Completing Client Quarterly Client Presentations and File Reviews
- Managing Medical Treatment
- Working with Defense Counsel to determine strategy for early resolution of claims.
- Completing contacts on New Losses and Determining Compensability
Resolution/Senior Workers' Compensation Claims Examiner
Sedgwick Claims Management Services
03.2013 - 03.2015
- Managing of highly complex claims for national retail clients
- Identifying and bringing cases to resolution
- Maintaining aggressive closing ratio
- Determining effective legal strategy and providing direction to defense attorneys
Workers' Compensation Claims Examiner
Southern California Gas Company
12.2008 - 02.2013
- Handling of complex litigated claims for self-insured, self-administrated employer
- Determining OSHA status of new claims and updating safety records
- Investigating delayed claims and making timely decision within 90 days
- Providing superior customer service to clients, claimants and vendors
- Integrating payroll, social security, non-industrial illness, FMLA and long term disability benefits
- Completing reasonable accommodation process and facilitating return to work process
- Providing direction to defense attorneys for timely resolution of claims
- Reporting Excess claims to carrier for recovery
Education
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Xavier University of Louisiana
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West Los Angeles College
Skills
- Teamwork and communication
- Teamwork and collaboration
- Strong work ethic
- Teamwork
Certification
- Insurance Education Association (IEA) WCCA certificate, 2006
- WCCP Certificate, 2009
- Department of Self Insurance Plans Certificate, 06/01/07
Timeline
Senior Workers’ Compensation Adjuster
PRG Staffing
10.2025 - Current
Claims Specialist
American Equity Underwriters
11.2020 - 10.2024
Senior Workers' Compensation Examiner
Keenan & Associates
10.2016 - 10.2020
Senior Workers' Compensation Representative
ESIS/ACE Group
03.2015 - 10.2016
Resolution/Senior Workers' Compensation Claims Examiner
Sedgwick Claims Management Services
03.2013 - 03.2015
Workers' Compensation Claims Examiner
Southern California Gas Company
12.2008 - 02.2013
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Xavier University of Louisiana
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West Los Angeles College