Renee Coker
San Leandro,United States
Summary
Knowledgeable MO/Future Medical Adjuster with solid background in customer service .
Overview
33
33
years of professional experience
Work History
MO/Future Medical Adjuster
LWP CLAIMS SOLUTIONS
Sacramento, CA
05.2025 - Current
- Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Negotiates settlement of future medical claims within designated authority
- Calculates and assigns timely and appropriate reserves to claims based on Self-Insured Plans guidelines for future medical claims; manages reserve adequacy throughout the life of the claim; Update reserves no later than 10 days of receipt of information modifying the financial exposure of a claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments and settles claims within designated authority level
- Reports claims to the excess carrier.
- Conduct initial investigations to determine claim coverage and compensability under state statutes and employer policies.
- Medical Coordination: Monitor ongoing medical treatment, authorize necessary procedures/therapies, and facilitate safe return-to-work plans.
- Bill Review & Processing: Review medical bills, ensure accurate coding, and authorize timely payments to medical providers.
- File Management: Maintain accurate, timely documentation in the claims system, establish proper financial reserves, and prepare routine status reports.
- Customer Service: Address questions and concerns from injured employees, employers, and medical professionals while managing expectations.
Medical Only Adjuster/Future Medical Adjuster/Claims Assistant
HAZELRIGG CLAIMS
Oakland, CA
09.2014 - Current
- Provide customer service – answer telephones by the third ring and re-direct callers as necessary to properly respond to customer inquiries.
- Complete three-point contact to properly investigate assigned claims, evaluate coverage and determine compensability.
- Perform data entry to setup new claims, work diaries and create activity notes.
TRISTAR
01.2021 - 05.2023
- TRISTAR bought Hazelrigg claims
Claims Assistant
ZENITH INSURANCE
Pleasanton, CA
05.2013 - 09.2014
- Responsible for assisting examiners and management of assigned caseload by performing clerical functions according to the Zenith timeframes and guidelines.
- Performs detailed telephone investigations and maintains disability status checks with physicians and policyholders as directed by examiner.
- Arranges medical examinations; may send physician cover letter with assistance or approval of examiner, and compose routine narrative memorandums and letters as directed by examiner.
- Prepares and types legal documents; Answers, Declaration of Readiness to Proceed, Compromise and Release, and other related forms and memorandums.
- Makes disability and medical payments within given authority. Inputs and monitors automatic disability schedule payments and cancellations.
- Timely management of assigned tasks by systems diary.
- Proficient use of computer to include claims information, coverage, DWC notices and payment verification. Word, Outlook Calendar, E-Mail, Performa, and Zeus knowledge required.
- Calculate wage statements and make appropriate adjustments in the system.
- Understands and complies with medical management protocols and standards.
- May assume back-up in absence of examiner.
- Assists in training of claims assistants and other clerical personnel. Works productively and harmoniously with others on a consistence basis.
- Respond positively to direction and criticism of performance.
- Consistently maintain professional and appropriate demeanor.
- Perform other duties as assigned.
Claims Assistant
AIG
San Francisco, CA
08.2006 - 01.2013
- Provide necessary clerical support in the form of reporting, maintaining register logs, file set-up, and administration of claims paperwork for San Francisco and Seattle offices
- Process and insure accurate data entry and payments as directed by authorized offices or Home Office personnel for local and overseas claims and all monthly LPR's before close of month which include wire transfers
- Handle CM overseas cargo claims
- Handle Microsoft monthly report
- Handle one shot claims
- Supported testing of new claims reporting system including distribute on of announcements as well as relaying system problems and concerns to the appropriate home office representatives.
- Assisted Regional Claims Manager on financial reconciliation from an Insured involving over $3M in dispute. Retrieved over 100 files from storage to obtain documents to send to Legal Counsel review.
- Assist with vendor management reporting and obtaining W9's from all outstanding vendors.
- Process and keep logs of all incoming and outgoing checks including deductible reimbursement checks and overpayments that need to be accounted back to claim file
- Order and maintain supplies for department
Claims Assistant
TRAVELERS INSURANCE
Walnut Creek, CA
02.2004 - 08.2006
- Typed benefit notices
- Submitted legal stipulations with request for award and compromise and release to Workers' Compensation Appeals Board Judge
- Requested wage statements from Insured's
- Set up new claim files
- File and serve documents to attorneys
- Scheduled medical appointments for the injured workers
- Submitted referrals to Utilization Review for authorization of medical treatment, physical therapy treatment, etc.
- Paid any invoices associated with claim
Medical Only Claims Analyst/Claims Associate
KEMPER INSURANCE
Concord, CA
10.1993 - 02.2004
- Made 3 point contact on new claims
- Took recorded statements on new claims
- Handled over 500 future medical claims
- Paid out the permanent disability award on future medical claims and monitored their medical treatment
- Worked closely with medical facilities and physical therapy facilities
Claims Clerk III
10.1993 - 10.2001
- Administrative duties assisting eight adjusters with over 1,000 files relating to workers' compensation Submission of legal stipulations with request for award and compromise and release to Workers' Compensation Appeals Board Judge
- Request wage statements from employers
- Temporary, permanent, vocational rehabilitation benefit notices sent to injured workers
- Sorted and indexed large volumes of mail
- Set up all lines of insurance claims entering on an Excel spreadsheet
- Trained co-workers and new employees
- Sent service kits to new insured companies
- File and served documents to interested parties
- Disclaimer letters and recorded statements typed using transcribing machine
- Assist co-workers in their workflow
- Back-up for Assistant Supervisor in distribution of claim set ups to supervisors
- Accounts payable including logging in of checks
- Back up for receptionist
Education
Secretarial
Heald Business College
Walnut Creek, CA, United StatesSkills
- Insurance Education Association (IEA) Workers' Compensation Certificate
- Self Insurance Administrator Certificate - Qualified Administrator - 6/22/17
Timeline
MO/Future Medical Adjuster
LWP CLAIMS SOLUTIONS
05.2025 - Current
TRISTAR
01.2021 - 05.2023
Medical Only Adjuster/Future Medical Adjuster/Claims Assistant
HAZELRIGG CLAIMS
09.2014 - Current
Claims Assistant
ZENITH INSURANCE
05.2013 - 09.2014
Claims Assistant
AIG
08.2006 - 01.2013
Claims Assistant
TRAVELERS INSURANCE
02.2004 - 08.2006
Medical Only Claims Analyst/Claims Associate
KEMPER INSURANCE
10.1993 - 02.2004
Claims Clerk III
10.1993 - 10.2001
Secretarial
Heald Business College