NAEEMAH SHAH
Buffalo,NY
Summary
Licensed New York State workers' compensation claims specialist with proven expertise in auditing and managing complex, high-exposure claims. Skilled in training teams and optimizing operational procedures to enhance efficiency. Dedicated to delivering exceptional customer service and achieving optimal claim outcomes.
Overview
25
25
years of professional experience
Work History
Senior Claims Consultant
Alan Gray, LLC
11.2021 - Current
- Conducted workers’ compensation claim audits to ensure compliance with client handling instructions and best practice standards.
- Analyzed audit outcomes to pinpoint areas for improvement, detailing findings in comprehensive reports.
- Provided actionable recommendations to enhance future performance based on audit results.
Claim Technical Specialist
Church Mutual Insurance Company
07.2021 - 11.2021
- Resolved complex, high-exposure claims through settlements, stipulations, or litigation.
- Established timely, accurate reserves while pursuing offsets to mitigate exposure.
- Communicated with claimants, insureds, and attorneys to address issues and concerns.
- Reviewed claim resolution strategies with management, securing authorization when necessary.
Workers Compensation Team Manager
Next Level Administrators
11.2020 - 07.2021
- Managed team of five adjusters overseeing multi-jurisdiction claims.
- Conducted supervisor reviews at 11 days, 30 days, and every 90 days thereafter.
- Facilitated daily video conferences to verify EDI form completion per NYS standards and address team inquiries.
- Communicated with internal and external parties regarding progress and objectives.
- Reviewed and approved reserve and settlement evaluations to ensure accuracy.
- Participated in claim file reviews, daily roundtables, and audits to uphold best practices.
Workers Compensation Supervisor
Armour Risk Management
Amherst, NY
09.2016 - 11.2020
- Oversaw team of four adjusters managing approximately 1,000 multi-jurisdiction claims.
- Conducted biannual reviews for each claim to identify risk mitigation actions and negotiate settlements.
- Facilitated communication between adjusters and management to enhance performance and resolve workflow issues.
- Managed external communications with attorneys, medical providers, vendors, and claimants to effectively resolve disputes.
Claim Resolution Specialist
Travelers Insurance
Buffalo, NY
10.2014 - 09.2016
- Responsible for the resolution of claims expected to result in a loss of wage earning capacity.
- Files postured for settlement by pursuing all applicable offsets, reducing the degree of disability and aggressively pursuing medical cost savings.
- Settlement authority pursued and obtained from all needed parties.
- Communication maintained with the employer, injured worker and medical provider.
Senior Claim Representative
ESIS
Cheektowaga, NY
11.2006 - 10.2014
- Investigated and determined compensability on workers' compensation claims for national accounts.
- Completed 24 hour three point contact on newly assigned claims.
- Set and recommended initial and subsequent reserves.
- Pursued light and full duty work releases.
- Partnered with medical, legal and vocational specialists to obtain optimal file outcomes.
- Negotiated settlements and attended in person and telephonic claim file reviews.
- Adhered to account instructions and filed appropriate state forms.
- Maintained communication with the employer and injured worker.
- Calculated and issued timely and appropriate payments.
Claim Resolution Case Specialist
Travelers Insurance
Buffalo, NY
05.2001 - 11.2006
- Assigned to complex and high exposure claims once return to work efforts had been exhausted.
- Determined the most effective strategy to mitigate exposure and resolve claims.
- Pursued Second Injury Fund relief, apportionment and negotiated Section 32 settlements.
- Set reserves, administered benefits and participated in claim file reviews.
- Worked closely with defense counsel to provide direction and resolve any outstanding legal issues.
Education
J.D. - Law
State University of New York at Buffalo
Buffalo, NYBachelor of Arts - Communications
State University of New York at Buffalo
Buffalo, NYSkills
- Oversight of multiple jurisdictions
- Deadline management in fast-paced environments
- Medical terminology expertise
- Offset identification and pursuit
- Negotiation skills
- Notary public certification
Timeline
Senior Claims Consultant
Alan Gray, LLC
11.2021 - Current
Claim Technical Specialist
Church Mutual Insurance Company
07.2021 - 11.2021
Workers Compensation Team Manager
Next Level Administrators
11.2020 - 07.2021
Workers Compensation Supervisor
Armour Risk Management
09.2016 - 11.2020
Claim Resolution Specialist
Travelers Insurance
10.2014 - 09.2016
Senior Claim Representative
ESIS
11.2006 - 10.2014
Claim Resolution Case Specialist
Travelers Insurance
05.2001 - 11.2006
J.D. - Law
State University of New York at Buffalo
Bachelor of Arts - Communications
State University of New York at Buffalo