Polly Snodgrass-Evans

Workers' Compensation Claims Adjuster

Sedgwick CMS

Omaha, NE

03.2016 - Current

Analyzed data from multiple sources to identify trends that could affect future decisions regarding workers' compensation claims.
Assessed current policies and procedures related to processing workers' compensation claims for effectiveness and recommend changes as needed.
Provided customer service by responding promptly to inquiries from claimants, employers, attorneys and other stakeholders.
Investigated workers' compensation claims to determine eligibility and extent of coverage.
Reviewed medical records, interviewed employers and claimants, analyzed wage loss calculations, and reviewed evidence for accuracy.
Prepared detailed reports on claim findings including all pertinent information such as injury description, cause of accident, employer responsibility, and liability.
Participated in regular meetings with internal teams and external partners regarding ongoing projects related to worker's compenstion claims management.
Maintained accurate records of all claim activities including correspondence, reports, investigations, settlements.
Monitored industry developments in order to stay abreast of changes in legislation affecting workers' compensation claims process.
Processed benefit payments in accordance with applicable laws and regulations.
Coordinated with medical professionals to arrange treatment for injured claimants and provide relevant information to medical offices regarding policy coverage and claimant work conditions.
Monitored claim progress and issued appropriate notices to maintain continued progress on claim processing and eliminate liability to company.
Completed continuing education courses to remain current on applicable laws and expand upon understanding of relationships between statutory requirements and company policies.
Conferred with claimants to gather additional claims information and educate on claim processes, terms and conditions, requirements and ramifications of filing claim.
Maintained current knowledge of claim reserve levels and prepared reports on funds available for distribution to claimants to prevent overdraft.
Administered workers' compensation program covering injured employees.
Determined liability, compensability, and benefits due on each claim.
Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
Discussed current cases and issues in claim committee meetings.
Input claim information and payments into company database.
Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
Reviewed police reports, medical treatment records, medical bills and physical property damage to determine extent of liability.
Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
Analyzed information gathered by investigations and reported findings and recommendations.