PATRICIA O'KONSKI
Riverside,CA
Summary
Experienced and resourceful insurance claims professional with extensive multi-line, multi-state Workers' Compensation experience in carrier and in third party administration environments. Highly organized and efficient in a fast-paced environment, communicating effectively at all organizational levels, with clients and stakeholders. Demonstrated ability to build trusting relationships. Ability to think critically, solve problems, plan and organize activities and deliver excellent customer service. Seeking a challenging position with a progressive, dynamic company.
Overview
33
33
years of professional experience
1
1
Certification
Work History
Senior Resolution Manager
PRG Recruiters
Irvine, CA
10.2023 - Current
- Explained loss coverage, assisted policyholders with itemizing damages and coordinated alternative living arrangements.
- Handled and processed workers' compensation claims for several clients.
- Reviewed specific and aggregate claims and consulted with clients to assess completeness and compliance.
- Paid and processed claims within designated authority level.
- Obtained necessary information to complete proper evaluation of injury claims.
- Negotiated settlements with claimants or their representatives in order to reach an equitable resolution.
Senior Claims Examiner
AmTrust Insurance
Irvine, CA
03.2022 - 10.2023
- Handled and processed workers' compensation claims of all types of severity.
- Explained loss coverage, assisted policyholders with itemizing damages and coordinated alternative living arrangements.
- Reviewed specific and aggregate claims and consulted with clients to assess completeness and compliance.
- Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
- Paid and processed claims within designated authority level.
- Identified potential fraud indicators during reviews of submitted documents.
- Obtained necessary information to complete proper evaluation of injury claims.
- Analyzed medical records to identify discrepancies between the claim and treatment history.
- Attended court proceedings as a representative of the company when necessary.
- Negotiated settlements with claimants or their representatives in order to reach an equitable resolution.
Third Party Claims Manager
Midwestern Insurance Alliance
San Diego, KY
May - 02.2022
- Provide oversight on third party, multiple jurisdictional insurance programs
- The programs involved hundreds of claims and over a dozen examiners and other managers
- Daily work involved dozens of phone calls and emails across multiple time zones in addition to daily teleconference appointments used to gather information to oversee claims process with these third party carrier
- Review and authorize reserves and financial benefits upon request from third party administrators
- Ensure that third party administrators issue benefits on a timely basis
- Ensure that claims are investigated and follow a proper course of action for claims processing pursuant to each individual claim jurisdiction
- Monitor claims within the program on a consistent diary
- Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times
- Oversee that the third party claims consistent with client and corporate policies, procedures, best practices and jurisdictional regulations
- Documented and communicated timely claims information while supporting accurate outcomes
- Provide exceptional customer service to policyholders as well as underwriting and agents associated with the programs involved by communicating important information and patiently listening to all issues
- Monitored social media and online sources for industry trends.
Senior Claims Specialist
AIG
San Diego, CA
09.2012 - 05.2015
- Remote employee working as a senior claim analyst for Claims Plus accounts in the construction division
- Review and administer Workers' Compensation benefits for claims for large policy insured clients
- Provide client status account reviews and attend client meetings as required.
Senior Claims Specialist
The Hartford
Sacramento, CA
12.2010 - 09.2012
- Remote employee working as a claim examiner for Claims Plus accounts in the healthcare and hospital division
- Review and administer Workers' Compensation benefits for claims for large policy insured clients
- Provide client status account reviews and attend client meetings as required.
Senior Claims Specialist
Cor Vel Corporation
San Diego, CA
02.2007 - 12.2010
- Review and administer Workers' Compensation benefits for claims as the third-party claim administrator for the self-insured San Diego JPA School District Fund
- Provide client status account reviews and attend client meetings as required
- Attend legal proceedings as required.
Account Manager
Frank Gates Service Company
Anaheim, CA
06.2004 - 02.2007
- Dedicated examiner and account manager for alternative market captive program
- Review and administer Workers' Compensation benefits for claims in capacity as third party administrator, on-site at the client location
- Evaluate and provide loss control information as requested
- Provide advice to client human resource departments as requested
- Advise the underwriting department of account claim trends
- Review loss runs and meet with underwriting department as required for semi-annual review and annual renewal process
- Provide client status reports and attend client meetings as required.
Unit Manager
Cambridge Integrated Services Company
Costa Mesa, CA
02.2004 - 06.2004
- Review and administer Workers' Compensation benefits for claims as third party administrator for self-insured Fortune 500 client, K-Mart
- Provide client status account reviews and attend client meetings as required.
Senior Claims Examiner
Sedgwick Claims Management Service
Orange, CA
07.2002 - 02.2004
- Review and administer Workers' Compensation benefits for claims as third-party administrator for self-insured Fortune 500 client, Home Depot
- Provide client status account reviews and attend client meetings as required.
Senior Claims Examiner
Insurance & Technology Staffing Services
Newport Beach, CA
03.2001 - 06.2002
- Review and administer Workers' Compensation benefits for claims as third-party administrator for self-insured clients for a long term temp assignment
- Administer CIGA files as requested
- Review and analyze large loss files as assigned
- Review and administer benefits for multi-state Workers' Compensation claims as assigned
- Administer insured and self-insured claims as assigned.
Unit Manager and Claims Supervisor
Golden Eagle Insurance Corporation
San Diego, CA
08.1994 - 03.2001
- Due diligence transition team lead contact
- Customer service project management team member
- OBAE supervisor review lead contact
- Supervisor of Northern California claim accounts
- Supervised two claims teams of 10 examiners, 4 clerical assistants and 1 registered nurse case manager
- Claim unit count was 1500 files
- Reserves in excess of $100 million
- Developed and implemented training program for claims trainees
- Completed and provided annual employee reviews
- As examiner, responsible for administration of benefits for large loss and complex litigation claims.
Senior Claims Examiner
CNA Insurance Companies
Reading, Brea, Glendale, PA, CA
05.1991 - 07.1994
- Member of national catastrophic claims team, a position that required 24/7 availability and flexibility
- Assisted planning, development and opening of new claim branch in Glendale, CA
- Structured settlement coordinator for Glendale branch, responsible for training examiners in annuity sales
- Also responsible for branch annuity goals
- As senior examiner, responsible for administration of benefits for workers' compensation claims as assigned
- Multi-state workers' compensation experience
- Also, multi-state experience with property claims, liability claims, medical malpractice claims, auto and bodily injury claims.
Education
Bachelor of Arts - Political Science
King's College
Skills
- Experienced with litigation of complex claims and complex issues
- Project management experience for claims oversight and company development projects for process improvement
- Extensive experience with training and application of structured settlements as an alternative settlement option
- Subject matter coverage expert for OCIP and CCIP claims
- Supervision and management of multiple teams of adjusters and nurse case managers
- Extensive experience in benefits administration in multiple jurisdictions
- Client focused with emphasis on delivering customer service satisfaction
- Knowledgeable and experienced in claims for multiple US jurisdictions
- Experienced in investigation and research of suspect and potentially fraudulent claims
Certification
- Associate in Risk Management 54, Introduction to Risk Management Associate in Risk Management 56, Risk Financing
- IEA WCCP certification
- IEA WCCA certification
- California Self-Insurance certification
Timeline
Senior Resolution Manager
PRG Recruiters
10.2023 - Current
Senior Claims Examiner
AmTrust Insurance
03.2022 - 10.2023
Senior Claims Specialist
AIG
09.2012 - 05.2015
Senior Claims Specialist
The Hartford
12.2010 - 09.2012
Senior Claims Specialist
Cor Vel Corporation
02.2007 - 12.2010
Account Manager
Frank Gates Service Company
06.2004 - 02.2007
Unit Manager
Cambridge Integrated Services Company
02.2004 - 06.2004
Senior Claims Examiner
Sedgwick Claims Management Service
07.2002 - 02.2004
Senior Claims Examiner
Insurance & Technology Staffing Services
03.2001 - 06.2002
Unit Manager and Claims Supervisor
Golden Eagle Insurance Corporation
08.1994 - 03.2001
Senior Claims Examiner
CNA Insurance Companies
05.1991 - 07.1994
Third Party Claims Manager
Midwestern Insurance Alliance
May - 02.2022
Bachelor of Arts - Political Science
King's College
Similar Profiles
Ida ChildsIda Childs
Substitute Teacher at PRG (Professional Recruiters Group)Substitute Teacher at PRG (Professional Recruiters Group)
Jordan T. BonkJordan T. Bonk
Sales Internship at Outsource RecruitersSales Internship at Outsource Recruiters
Logan CohnLogan Cohn
Associate Property Manager at PRG ManagementAssociate Property Manager at PRG Management