Robin Kelley

• Evaluated eligibility for benefits by analyzing case facts and applying relevant laws.
• Evaluated claims for validity based on established rules and regulations.
• Conducted interviews with claimants, employers, physicians and other healthcare providers to gather pertinent information for claims.
• Identified potential fraudulent activities by carefully analyzing data and uncovering any irregularities or discrepancies.
• Recommended appropriate actions based on review findings including denial or approval of benefits payments.
• Compiled evidence from diverse sources, including medical records, employment histories, and legal documents.
• Interacted professionally with customers, internally and externally, providing clear explanations for decisions made regarding their claims or concerns.
• Researched complex issues related to specific cases involving multiple parties or unusual circumstances.
• Provided guidance regarding workers' compensation compliance issues for employers.
• Reviewed medical records and other documents to evaluate the nature and extent of disability or injury.
• Prepared detailed reports outlining findings from investigations into workers' compensation claims.
• Researched legal precedents relevant to specific cases.
• Developed case strategies for complex matters requiring litigation.
• Negotiated settlements with attorneys representing claimants in order to resolve disputes quickly and efficiently.
• Attended hearings and mediations in order to represent employers or insurance companies in workers' compensation cases.
• Monitored changes in legislation pertaining to workers' compensation policies.
• Actively participated in continuing education courses related to workers' compensation laws and regulations.
• Reviewed invoices from health care providers, nurse case managers and attorneys for accuracy prior to payment processing.
• Maintained accurate records of all activities related to assigned cases using an electronic system.
• Determined compensability of claims according to state laws, regulations, policies and procedures.
• Calculated benefits payments due based on analysis of wage data, medical reports and other criteria.

Licensed and highly experienced in multiple jurisdictions. TN, KY, GA, MS, NC, SC, VA, AR, AL, NH, FL.

Designations from The Institutes

AIC, AINS, INS

• Experienced multi-state licensed adjuster
• Jurisdictions include: TN, KY, NC, SC, VA, GA, MS, AL, AR
• Excellent communication and relationship building with insureds, claimants, attorneys, medical professionals, and nurse case managers
• Evaluate and Reserve claims
• Litigation, mediation, negotiations, creative settlement skills
• Provide clients with the highest level of customer service possible.

• Lost time claims adjuster
• Multiple state licensed
• Customer claim reviews
• Reserving
• Litigation
• Subrogation.

• Medical only and lost time claims handling Tennessee claims
• Customer service
• Bill pay and reserving.