Migdalia Perez
Vineland,NJ
Summary
Qualified Claims and Risk professional versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering over 15 years of Risk and Claims experience. Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Excellent reputation for resolving problems and improving customer satisfaction.
Overview
38
38
years of professional experience
Work History
Claims Examiner
Sedgwick Claims Management
05.2024 - 08.2025
- Evaluated claims for accuracy and compliance with company policies.
- Collaborated with stakeholders to gather necessary documentation for claims processing.
- Analyzed complex claims to identify discrepancies and resolve issues effectively.
- Mentored junior examiners on best practices and industry regulations.
Workers Compensation Analyst
Claims Resolution Corporation, Inc.
11.2022 - 12.2023
- Analyzed information gathered by investigations to report findings and recommendations.
- Prepared summaries of work status, treatment follow ups, payments, and policy coverage.
- Established relationships with clients and insurance companies to foster timely claims resolution.
- Organized, planned and documented materials for workers comp claims.
- Viewed reports regularly to make sure processing was conducted efficiently.
- Maintained strict confidentiality with all personal data as per company guidelines.
- Worked with private investigators and attorneys on preparation of evidence, witness statements and other documentation in preparation for trial.
- Maintained contact with claimants and attorneys to determine treatment status.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
Senior Claims Adjuster
Qual-Lynx Cigna
05.2021 - 11.2022
- Interviewed claimants and witnesses to gather factual information.
- Investigated and processed workers comp insurance claims for policyholders.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Established relationships with clients and insurance companies to foster timely claims resolution.
- Substantiated legitimate claims and denied unjustified claims.
- Documented all investigation activity and presented reports to management.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Claims Representative
CCMSI
04.2016 - 03.2021
- Investigate and adjust workers compensation claims in accordance with established claims handling procedures using CCMSI guidelines and direct supervision
- Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims
- Negotiate any disputed bills for resolution
- Authorize and make payment of workers compensation claims utilizing a claim payment program in accordance with industry standards and within settlement authority
- Negotiate settlements with claimants and attorneys in accordance with client's authorization
- Assist in selection and supervision of defense attorneys
- Assess and monitor subrogation claims for resolution
- Prepare reports detailing claims, payments and reserves
- Provide reports and monitor files, as required by excess insurers
- Compliance with Service Commitments as established by team
- Delivery of quality claim service to clients
- Performs other duties as assigned.
Claims Coordinator/Legal Risk Management
Trump Entertainment
08.2011 - 01.2013
- Provide administrative support for Risk Control Manager
- Compile data from various sources within the company, track claims, set up database for in house handling of claims
- Claims handling: General Liability, Workers Compensation and Litigation matters
- Report quarterly OSHA claims
- Proven ability to organize, multitask and problem solve
- Act as an interpreter for Spanish speaking employees and guest whenever necessary
Risk Management Administrator
Harrah’s Resort
03.1987 - 06.2011
- Investigate claims by interviewing claimants, employers, witnesses and physicians
- Monitor medical treatment in conjunction with Medical Management personnel
- Provide prompt authorization of medical services
- Coordinate light-duty availability with medical providers and employers
- Reviews First Report of Injury for accuracy
- Maintain Security Reports: download and coordinate transferring information to the Third Party Administrator via an online Liability Claims system and electronic photo submission
- Provide support/assist Risk Manager with monthly safety meetings
- Strong interpersonal skills in client communication and relations
- Proven ability to organize, multitask and problem solve
- Act as an interpreter for Spanish speaking employees
Education
No Degree - Medical Coding And Billing
Atlantic Cape Community College
Cape May, NJ05.2011
High School Diploma -
Millville Senior High School
Millville, NJ06.1986
Skills
Documentation Review
Settlement Determinations
Accident Investigations
Reporting Skills
MS Office
Bilingual
Written and verbal communication
Computer Skills
Multitasking
Teamwork
Timeline
Claims Examiner
Sedgwick Claims Management
05.2024 - 08.2025
Workers Compensation Analyst
Claims Resolution Corporation, Inc.
11.2022 - 12.2023
Senior Claims Adjuster
Qual-Lynx Cigna
05.2021 - 11.2022
Claims Representative
CCMSI
04.2016 - 03.2021
Claims Coordinator/Legal Risk Management
Trump Entertainment
08.2011 - 01.2013
Risk Management Administrator
Harrah’s Resort
03.1987 - 06.2011
No Degree - Medical Coding And Billing
Atlantic Cape Community College
High School Diploma -
Millville Senior High School