PATRICE GADDIS
Alabaster,Alabama
Summary
Experienced workers' compensation adjuster with a successful history in settlement negotiation and case analysis, recovering millions in claims. Expertise in risk management services from Sheffield, ensuring optimal outcomes for injured workers and stakeholders. Strong analytical skills and commitment to quality assurance drive effective results.
Overview
36
36
years of professional experience
Work History
Medical Only Workers Compensation Adjuster
Sheffield Risk Management Services
Birmingham, Alabama
10.2023 - 10.2026
- Conducted thorough investigations of claims within established timeframes after injury report receipt.
- Obtained detailed accounts of injury causes from employees to enhance claims evaluations.
- Requested medical records from hospitals and service providers to substantiate claims assessments.
- Verified additional details by contacting employers upon first injury report receipt.
- Maintained communication with injured workers and medical professionals to ensure effective treatment plan adherence.
- Coordinated appointment scheduling for injured workers and ensured attendance at follow-up visits.
- Evaluated incoming claims and forwarded them to billing department for processing.
- Assessed settlement decisions and identified opportunities for negotiation.
Workman’s compensation Analyst
Blue Cross and Blue Shield of Alabama
01.1998 - 07.2020
- Utilize web based system to manage case activities and analyze details to determine if workers compensation exists; analyze complex workers compensation cases to determine benefits due
- Pursued and negotiated recoveries from providers, subscribers, workers' compensation carriers, and attorneys through written, electronic, and verbal communications, enhancing recovery outcomes.
- Investigate new cases by reviewing first reports of loss and supporting materials to determine the best initial contact; communicate with claimant, policyholders/customers, attorneys, groups, etc
- Consult with state-specific legal counsel and adjuster and make final settlement recommendations to management; interface with adjusters, medical professionals, as well as workers compensation attorneys in every state
- Coordinated litigation efforts and conducted closed file reviews to ensure compliance and thoroughness in case assessments.
- Act as senior technical professional, assisting team members with escalated issues
- Trained counterparts to improve and evaluate processes while monitoring team performance.
- Researched claims data to support recovery of millions and managed pursuit of workers’ compensation dollars throughout each case's lifecycle.
Inquiry Analyst
Blue Cross and Blue Shield of Alabama
01.1997 - 01.1998
- Responded promptly to inquiries, concerns and problems related to patient billing; answered inquiries generated from Customer Service and other areas of the company
- Verified information and processed claims in accordance with benefit agreements; coordinated benefits with other insurance companies
- Updated claims by using the correct CPT/Revenue Codes, ICD-9 diagnosis and procedure coding guidelines; updated J segment
- Demonstrated knowledge of UB1500 electronic and hardcopy billing forms, formats, and filing requirements
- Analyzed, and processed ITS claims through the database; provided support on special project assessments as needed.
Customer Service Representative
Blue Cross and Blue Shield of Alabama
01.1991 - 01.1997
- Received, investigated, and resolved all customer inquiries timely and accurately; provided efficient professional service to subscribers and providers
- Quoted benefits according to contractual benefit agreement; ensured all customer communication was clearly documented
- Conducted training sessions for new Customer Service Representatives, improving their service skills and knowledge.
Education
Bachelor of Science Degree - Business Administration ADDITIONALCOURSES Case Law
Faulkner University
Montgomery, AlabamaSkills
- Core competencies in workers' compensation laws
- MS Office applications
- Subject matter expertise
- Quality assurance and review
- ITS processing
- Research and resolution
- Case analysis
- Settlement negotiation
- Analytical expertise
Timeline
Medical Only Workers Compensation Adjuster
Sheffield Risk Management Services
10.2023 - 10.2026
Workman’s compensation Analyst
Blue Cross and Blue Shield of Alabama
01.1998 - 07.2020
Inquiry Analyst
Blue Cross and Blue Shield of Alabama
01.1997 - 01.1998
Customer Service Representative
Blue Cross and Blue Shield of Alabama
01.1991 - 01.1997
Bachelor of Science Degree - Business Administration ADDITIONALCOURSES Case Law
Faulkner University