Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Graduate of Leadership Columbia, Mo Chamber of Commerce December 2012
Timeline
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Michelle Sells

Prairie Home,MO

Summary

Accomplished Workers Compensation Specialist with a proven track record at Columbia Insurance Group, showcasing expertise in regulatory knowledge and exceptional relationship building. Excelled in settlement negotiations and case evaluations, achieving significant efficiencies in claim processing. Mentored junior staff, enhancing professional growth and improving negotiation outcomes.

Overview

23
23
years of professional experience
1
1
Certification

Work History

Workers Compensation Specialist

Columbia Insurance Group
08.2015 - Current
  • Examine claims forms and other records to determine insurance coverage.
  • Deliver exceptional customer service to policyholders, claimants, medical providers, attorneys, vendors and nurse case managers by communicating important information and patiently listening to issues.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Reviewed new files to determine current status of injury claim and to develop plan of action.
  • Maintain consistent contact with claimants, nurse case managers, medical providers and attorneys to provide excellent customer service.
  • Currently handle thirteen different jurisdictions which include Kansas, Missouri, Illinois, Arkansas, Iowa, Nebraska, South Dakota, Mississippi, Georgia, Tennessee, Alabama, Texas and Oklahoma.
  • Directed claims negotiations within authority limit and supported successful litigations for advanced issues.
  • Managed average of 50 calls, emails and faxes per day from insureds, claimants, attorneys, nurse case managers and medical providers.

Human Resources Specialist

Columbia Insurance Group
05.2010 - 08.2015
  • Reviewed and screened applicant resumes to identify qualified candidates.
  • Maintained personnel records and statistical data for 200 employees to establish accuracy and compliance with applicable regulations.
  • Managed benefits administration for company-wide staff, ensuring timely processing and accurate recordkeeping.
  • Conducted routine HR audits to ensure data accuracy in personnel files, payroll records, and benefit enrollments.
  • Fielded employee inquiries related to insurance, pension plan, vacation, sick leave and employee assistance.
  • Led open enrollment periods for health insurance coverage options, assisting employees in making informed decisions regarding their benefits selections.

Staff Adjuster

Columbia Insurance Group
09.2006 - 05.2010
  • Maintained strong relationships with policyholders, agents, and colleagues by consistently demonstrating professionalism, empathy, and effective communication skills.
  • Ensured compliance with state regulations and company policies through diligent review of all claim-related materials.
  • Assisted clients in understanding their insurance coverage by explaining complex terms and conditions clearly and concisely.
  • Improved claim processing efficiency by conducting thorough investigations and promptly addressing discrepancies.
  • Investigated and assessed damage to property and reviewed property damage estimates.
  • Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.

Casualty Claims Specialist

Shelter Insurance Companies
04.2001 - 09.2006
  • Negotiated settlements with claimants and their representatives, achieving fair resolutions while minimizing financial risk.
  • Served as mentor to junior staff members, providing guidance on claim handling procedures and professional growth opportunities.
  • Implemented proactive approach towards identifying potential risks leading to fewer false or inflated casualty claims.
  • Managed complex casualty claims, ensuring accurate evaluation of damages and appropriate settlement offers.
  • Conducted detailed investigations, gathering crucial information from claimants, witnesses, and experts to inform decision-making processes.
  • Developed strong relationships with external partners such as medical providers, adjusters, and repair facilities to expedite service delivery for policyholders during claims process.

Education

Bachelor of Arts - Business Administration

William Woods University
Fulton, MO
05.1999

Skills

  • Case Evaluation
  • Regulatory knowledge
  • Investigation techniques
  • Legal Compliance
  • Settlement Negotiations
  • Return-to-Work Programs
  • Active Listening
  • Relationship Building
  • Policy Interpretation
  • Claims Management
  • Critical Thinking
  • Decision-Making
  • Claims Evaluation
  • Report and Records Review

Accomplishments

  • Collaborated with team of 10 in the development of implementation of new Payroll software system

Certification

Workers Compensation Law Specialist Designation

  • Licensed adjuster in Texas and Oklahoma


Graduate of Leadership Columbia, Mo Chamber of Commerce December 2012

Leadership Columbia is a skills-building program that aims to develop local community leaders while providing an educational experience with a strong emphasis on social and community awareness.   This is a six month program, and I was part of the graduating class in 2012.

Timeline

Workers Compensation Specialist

Columbia Insurance Group
08.2015 - Current

Human Resources Specialist

Columbia Insurance Group
05.2010 - 08.2015

Staff Adjuster

Columbia Insurance Group
09.2006 - 05.2010

Casualty Claims Specialist

Shelter Insurance Companies
04.2001 - 09.2006

Bachelor of Arts - Business Administration

William Woods University
Michelle Sells