Migdalia Perez
Vineland
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
39
39
years of professional experience
Work History
Resolution Manager
Gallagher Bassett
02.2026 - Current
- Led resolution strategies to effectively address client concerns and enhance service delivery.
- Mentored teams in complex case management, fostering professional development and collaboration.
- Streamlined claims processing workflows, reducing turnaround times and improving overall efficiency.
- Implemented quality control measures to ensure compliance with industry regulations and client expectations.
- Resolved escalated issues promptly, ensuring alignment with organizational goals and maintaining client relationships.
- Evaluated existing policies and procedures, recommending changes that led to improved business efficiency and client satisfaction levels.
- Provided exceptional customer service by empathizing with clients'' concerns and offering tailored solutions to meet their needs.
- Negotiated dispute settlements with clients, securing favorable outcomes while preserving business relationships.
Claims Examiner
Sedgwick Claims Management
Mount Laurel, NJ
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.
- Reviewed and analyzed claims to ensure compliance with regulations and company policies.
- Investigated discrepancies in claims submissions, identifying resolutions to expedite processing.
- Implemented quality assurance measures to improve accuracy in claims assessments and decisions.
- Evaluated complex claims cases, making strategic recommendations based on thorough analysis of data.
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Directed claims negotiations within allowable limit of $100,000 + and supported successful litigations for advanced issues.
Workers Compensation Analyst
Claims Resolution Corporation, Inc.
Galloway, NJ
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
Piscataway, NJ
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
Languages
Spanish
Professional Working
Timeline
Resolution Manager
Gallagher Bassett
02.2026 - Current
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
High School Diploma -
Millville Senior High School
No Degree - Medical Coding And Billing
Atlantic Cape Community College