Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Norma Navarro

Summary

Claims Examiner with deep knowledge of workers' compensation claims industry. Solid abilities in developing objectives and strategies to settle workers' compensation claims. Excellent skills compiling, coding, categorizing and auditing information to process claims.


Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems.


Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Overview

21
21
years of professional experience

Work History

Sr. Claims Examiner

Keenan / AP
11.2002 - Current
  • Maintain current diary.
  • Identify, prevent and mitigate potential penalties.
  • Update claim notes in computer.
  • Provide timely reporting of excess files to the Reinsurance Manager.
  • Report SIU/Fraud.
  • Identify and pursue subrogation.
  • Complete Rehab forms/benefit notices/SJDB/RTW form.
  • Refer all PRIME deletions only to office designee.
  • Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim.
  • Prepare for and attend file reviews.
  • Accept or deny delayed claims within 90 days.
  • Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date.
  • Complete Stipulation and/or Compromise and Release paperwork.
  • Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually.
  • Prepare legal referrals, provide direction to and monitor defense attorney.
  • Return all phone calls within 24 hours.
  • Complete instruction for Assistant/Technician/Claims entry clerk.
  • Review mail daily.
  • Correct error report daily.
  • Maintain client/claimant satisfaction.
  • Update Unit Stat forms.
  • Oversee new set-ups, reserves and instruction sheets.
  • Prepare cover letters to AME/defense QME, AOE/COE evaluations.
  • Negotiate outstanding liens.
  • Make 3-point contact with 24hours.
  • File Answer/Application.
  • Interaction with nurse on case management.
  • Other duties assigned.
  • Familiarized clients with ED code and labor code as well as procedure and time frames

Education

High School Diploma -

James A. Garfield Senior High School
Los Angeles, CA
06.1987

Skills

  • Claims analysis
  • Investigation techniques
  • Verbal and written communication
  • Bilingual
  • Multi tasking
  • Team Collaboration
  • Active Listening
  • Settlement Negotiations
  • Liability Determination
  • Microsoft Office Suite
  • Claims Investigation
  • Computer Skills
  • Customer service and support

Languages

Spanish
Native or Bilingual

Timeline

Sr. Claims Examiner

Keenan / AP
11.2002 - Current

High School Diploma -

James A. Garfield Senior High School

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Norma Navarro