Michelle Head
Forney,TX
Summary
Organized Insurance Claims professional offering expertise in investigation, litigation and settlements. Proficient in executing claims transactions and applying settlement protocols to foster timely, fair and accurate claims processing. Track record of superior performance in team, leadership roles.
Overview
24
24
years of professional experience
Work History
Claims Adjuster
Randstad
Dallas, Tx
03.2026 - Current
- Analyzed claim data to identify discrepancies and potential fraud indicators.
- Evaluated claims to determine validity and adherence to policy guidelines.
- Communicated with clients to gather necessary documentation and information.
Senior Resolution Manager
Gallagher Bassett Services Inc.
Denver, Colorado
01.2024 - 08.2025
- Managed complex claims processes, achieving timely resolutions for clients.
- Collaborated with cross-functional teams to improve service delivery and elevate client satisfaction.
- Collaborated with cross-functional teams to enhance service delivery and client satisfaction.
- Developed training materials to support staff in claims handling and resolution techniques.
- Compiled and submitted summary reports for claims reviews to support decision-making.
Claims Examiner II
Sedgwick
01.2018 - 01.2024
- Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Negotiates settlement of claims within designated authority.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority.
- Calculated and assigned reserves to claims; managed adequacy throughout claim lifecycle.
- Evaluated claims to assess liability and determine coverage.
- Managed litigation process to achieve timely and cost-effective claims resolution.
- Implemented cost containment techniques to manage expenses.
- Prepares necessary state filings within statutory limits.
Litigation Senior Adjuster
Cole and Associates
01.2013 - 01.2019
- Prepared claim review on worker's compensation litigated claims involving the state of New Jersey.
- Prepared bankruptcy petitions for 80+ cases across various filing stages to ensure timely processing.
- Reviewed emergency cases and addressed client concerns regarding case management to enhance client satisfaction.
- Promoted client retention through high-quality service and consistent follow-through, achieving status as one of the top filers of bankruptcy petitions monthly.
Senior Resolution Manager
Professional Staffing Services
01.2017 - 01.2018
- Completed assignment at Gallagher Bassett and Sedgwick to manage claims.
- Processed claims in compliance with clients' and corporate policies for Texas and Oklahoma.
- Conducted investigations on new loss contacts to determine compensability and settlement exposure.
- Developed detailed action plans and conducted claims reviews with assigned clients.
Claims Supervisor
Claims Management Inc.
01.2007 - 01.2013
- Achieved cost savings through modifications in claims management, return-to-work program administration, and litigation management.
- Fostered professional growth and integrity among team members by motivating and inspiring them to achieve organizational goals.
- Developed skills, improved performance, and encouraged professional growth through motivated, influenced, and inspired team members to maintain a high level of integrity organizational goals.
- Directed and developed 10 adjusters in covering all the aspects of claims management under workers' compensation.
Senior Case Manager III
Claims Management, Inc.
01.2005 - 01.2007
- Completed timely and proper adjudication of claims based on jurisdiction.
- Completed continuing education and training programs to enhance professional knowledge of workers' compensation standards and practices in designated states.
- Reviewed case managers for adjusting claims in Texas, Iowa, New Jersey, and Arizona.
- Completed continuing education and training programs to enhance professional knowledge of workers compensation standards and practices in designated states.
Case Manager
Claims Management, Inc.
01.2003 - 01.2005
- Assessed client needs and developed individualized care plans.
- Coordinated services between clients and community resources.
- Monitored client progress and adjusted care plans as needed.
- Collaborated with policy holders, claimants, witnesses, and medical providers to gather critical information for compensability determinations.
- Monitored client progress and adjusted care plans.
Education
Business and Administration -
San Antonio Community College
Business and Administration -
Holyoke College
Skills
- Claims analysis
- Claims processing
- Fraud detection
- Claims negotiation
- Proficient in MS Office applications (Excel, Word, and MS Access)
- Detail-oriented
- Organizational skills
- Strong leadership
- Exceptional communication
- Interpersonal skills
- Business writing
- Conflict resolution
References
Upon Request
Timeline
Claims Adjuster
Randstad
03.2026 - Current
Senior Resolution Manager
Gallagher Bassett Services Inc.
01.2024 - 08.2025
Claims Examiner II
Sedgwick
01.2018 - 01.2024
Senior Resolution Manager
Professional Staffing Services
01.2017 - 01.2018
Litigation Senior Adjuster
Cole and Associates
01.2013 - 01.2019
Claims Supervisor
Claims Management Inc.
01.2007 - 01.2013
Senior Case Manager III
Claims Management, Inc.
01.2005 - 01.2007
Case Manager
Claims Management, Inc.
01.2003 - 01.2005
Business and Administration -
San Antonio Community College
Business and Administration -
Holyoke College