Ramona Nelson
Tampa, FL 33613-2539
Summary
Accomplished Claims Supervisor with extensive experience in claims analysis and team leadership. Recognized for fostering teamwork and implementing corrective measures that improve service delivery and operational efficiency.
Overview
29
29
years of professional experience
Work History
Claims Supervisor
Sedgwick Claims Management Services Inc.
Tampa, FL
08.2013 - Current
- Oversees claims processing workflows to ensure timely and accurate resolution of client cases.
- Implemented quality control measures to maintain accuracy in claims evaluations and decisions.
- Monitored performance metrics regularly, identifying areas for improvement and implementing corrective measures accordingly.
- Assisted in the recruitment and selection of new claims adjusters, ensuring they possessed the necessary skills and expertise to excel in their roles.
- Fostered a positive work environment that promoted collaboration, teamwork, and open communication among staff members.
- Developed strong relationships with external partners such as medical providers, attorneys, and investigators to facilitate effective information exchange during claim investigations.
- Mentored and trained team members on best practices and compliance standards in claims management.
- Analyzed claim data to identify trends and implement process improvements for operational efficiency.
- Collaborated with cross-functional teams to enhance service delivery and client satisfaction initiatives.
Call Center Claims Intake Center
Liberty Mutual
Tampa, FL
07.1997 - 08.2021
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Managed time efficiently in order to complete all tasks within deadlines.
- Proved successful working within tight deadlines and a fast-paced environment.
Senior Claims Examiner
Broadspire Claims Service
Tampa, FL
11.2005 - 07.2011
- Led complex claims investigations, ensuring compliance with industry regulations and company policies.
- Mentored junior claims examiners, enhancing team performance and knowledge retention.
- Streamlined claims processing workflows, reducing turnaround times and improving client satisfaction.
- Analyzed claim data to identify trends, driving strategic adjustments in claims management practices.
- Negotiated settlements with claimants, balancing fairness with fiscal responsibility to the company.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
Claims Examiner III
Liberty Mutual
Tampa, FL
08.2001 - 08.2005
- Evaluated claims for accuracy and compliance with company policies and state regulations.
- Analyzed complex insurance claims to determine validity and appropriate compensation levels.
- Collaborated with underwriting teams to refine risk assessment processes and improve claim outcomes.
- Mentored junior staff on best practices in claims processing and dispute resolution strategies.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Maintained current knowledge of industry developments, regulations, and best practices through continuous professional development activities.
Education
Bachelor of Science -
International Relations
University of South Florida
Tampa, FL05-1998
Skills
- Claims management expertise
- Team motivation
- Claims analysis
- Team management
- Quality assurance
- Performance monitoring
- Procedure implementation
- Customer expectations management
- Teamwork and collaboration
- Problem-solving
- Adaptability and flexibility
- Team building leadership
Workers Compensation Board Certified since 2009
License via Florida Department of Insurance - # E019287
Licensed in Kentucky, Tennessee, Georgia, North Carolina, South Carolina, Louisiana, Alabama, Mississippi
Timeline
Claims Supervisor
Sedgwick Claims Management Services Inc.
08.2013 - Current
Senior Claims Examiner
Broadspire Claims Service
11.2005 - 07.2011
Claims Examiner III
Liberty Mutual
08.2001 - 08.2005
Call Center Claims Intake Center
Liberty Mutual
07.1997 - 08.2021
Bachelor of Science -
International Relations
University of South Florida