Workers Compensation Captive Insurance Claims Expert with 360 degree technical expertise in the Workers' Comp insurance business. Bringing over 30 years of experience in all facets of the of the marketplace from adjusting to predictive analytics to program building. Multi-jurisdiction Claims Supervisor dedicated to quality investigation, adjustment, and supervision of diverse cases. Blends strategic planning and leadership strengths to establish top-performing claims departments. Trains and mentors staff, optimizing compliance with policies, procedures and applicable laws.
Overview
27
27
years of professional experience
Work History
Senior Workers Compensation Claims Supervisor
Cannon Cochran Management Services
12.2022 - Current
Developed staff skills through targeted training programs, resulting in improved performance and career growth opportunities.
Conducted performance evaluations for staff members, identifying areas of improvement and guiding professional development plans.
Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
Assisted Claims/Branch Manager operations ., specificlly- staffing and program plan proposals, caseload redistribution/reorganization, and presiding as acting Claims Manager in CM's Absence.
Mentored junior staff members in their career development, sharing knowledge from years of experience in the field.
Enhanced communication within the team by holding regular meetings and encouraging open dialogue among all members.
Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
Cultivated strong relationships with key clients or stakeholders through consistent communication and excellent service delivery.
Evaluated employee performance and coached and trained to improve weak areas.
Maintained compliance with company policies, objectives, and communication goals.
Regional WC Claims Supervisor
Creative Risk Solutions
02.2019 - 06.2022
Monitored team performance, enforcing compliance with corporate claims processes and procedures and carrier partner expectations.
Built talented teams of claims administrators dedicated to timely and compliant resolutions.
Cultivated productive relationships with stakeholders, facilitating claims lifecycle.
Built and re-constructed dividend generating Captive Insurance programs for client base.
Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times.
Prepared internal as well as state regulatory reports. Assist clients with their annual state regulatory reporting.
Identified improvement changes regarding key processes for internal controls and accounting procedures.
Analyzed and negotiated preferred vendor rates for additional corporate cost assurance.
Liaison between insured clients, carrier insurance company partners, and third party claims administrator.
Team Lead
Meadowbrook Insurance Group
06.2015 - 02.2019
Managing all facets of California Workers' Compensation claims adjustment from inception to finalization
Specialization in training, technical expertise, and major account education and retention
Enterprise Account Management and Policy holder liaison
Supervised team of 5 in addition to orientation and training of training program new hire associates
Project Management Teams: updating corporate policy and procedure manuals and best practices
Audit team member for quarterly Branch Service Audits, PAR Audit consultant
Development and revision of large self-insurance based specific excess insurance division including monitoring reported claims, claims management/proactive settlement round tables with TPAs, updating corporate reporting templates and audit criteria.
Senior Medical Record Review Auditor
Elevate Services
07.2013 - 07.2015
Elevate Services Medical Bill and Record Review Unit-Internationally recognized defense liability insurance industry expert witness testimony
Analyze medical records, billing and coding, and ancillary evidence to determine reasonable value of tort insurance cases
Knowledgeable in multiple state jurisdictions
Produce expert testimony preparation notes utilized by expert as reference during testimony.
Workers' Compensation Manager
Gardner Trucking, Inc
09.2011 - 08.2014
Brought Workers Compensation Program from small business to national corporate operational level
Slashed first year claims costs over 30% annually
Knowledge of WA, OR, IA, AZ, TX, and LA Workers' Compensation jurisdictions
Directed claims management services of out of state insurance administrator unit of 13 adjusters
Authored written Technical Aspects of Service (TAS) Directive component of underwriting contract, training and staff educational development, proactive claims management, and effective
Key Performance Indicators (KPIs)
Directed service expectations and communication standards for all vendors including defense attorneys and medical providers
Development and implementation of Federal OSHA/Cal OSHA compliant IIAPP policies and procedures including site based root cause/corrective action risk analysis and tracking systems
Developed and implemented written Industrial Injury policy and procedure section of corporate policy Employee and Safety Handbook.
Implemented Manager/Supervisor work related injury training sessions
Workers Compensation Compliance Officer
State of California DIR/OSIP
12.1997 - 07.2011
Responsible for auditing Southern California self-insured certificate holders for reserve adequacy
Maintaining optimum statutory compliance in accordance with department regulations
Provided cost containment analysis and strategic settlement consultation to third party administrators and self-administered certificate holders
Educate third party administrators and self-insured certificate holders regarding department regulations, current industrial labor statutes, and relevant case law.
Education
SIP Certified CA Experienced Adjuster Designation -
State of California
Office Of Self-Insurance Plans
Resident Workers Compensation Adjuster - #2883135
State of Texas
08.2022
Bachelor of Arts - English Literature
University of California
Riverside, CA
1986
Skills
Proactive claims resolution
Cost assurance and Contract Negotiation
Predictive Analytics
Project Management
Program development
Expert in Statutory Compliance/PAR Audit Consult
Client retention and education
Multi State experience
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Senior Workers Compensation Claims Supervisor
Cannon Cochran Management Services
12.2022 - Current
Regional WC Claims Supervisor
Creative Risk Solutions
02.2019 - 06.2022
Team Lead
Meadowbrook Insurance Group
06.2015 - 02.2019
Senior Medical Record Review Auditor
Elevate Services
07.2013 - 07.2015
Workers' Compensation Manager
Gardner Trucking, Inc
09.2011 - 08.2014
Workers Compensation Compliance Officer
State of California DIR/OSIP
12.1997 - 07.2011
SIP Certified CA Experienced Adjuster Designation -
State of California
Resident Workers Compensation Adjuster - #2883135
State of Texas
Bachelor of Arts - English Literature
University of California
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