Ryan Whitley
Lodi,CA
Summary
Results-driven Resolution Manager known for productive and efficient task completion. Specialize in conflict resolution, customer service management, and process improvement to navigate complex challenges effectively. Excel in communication, empathy, and problem-solving skills, ensuring successful outcomes in high-pressure environments. Maintain focus on achieving positive results while fostering team collaboration and client satisfaction. Seasoned Resolution Manager with broad experience in managing complex customer issues and disputes. Proven ability to de-escalate situations, resolve complaints, and ensure customer satisfaction. Strengths include strong problem-solving skills, exceptional communication abilities, and a keen focus on achieving company objectives. Previous roles have demonstrated high impact in improving customer relations and maintaining brand reputation.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Senior Claim's Resolution Manager
Gallagher Bassett Services Inc.
Folsom, CA
12.2022 - Current
- Developed detailed reports for senior management outlining the progress of each resolution case.
- Monitored customer feedback regarding resolution cases, making adjustments as necessary.
- Collaborated with external partners such as attorneys, auditors, and other third parties in order to resolve disputes efficiently.
- Utilized problem-solving skills in order to develop creative solutions for complex resolution issues.
- Negotiated settlements between conflicting parties when possible in an effort to avoid costly litigation expenses.
- Communicated regularly with customers about their cases providing updates as needed.
- Advised management on legal implications associated with proposed resolutions before decisions were finalized.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Resolved customer inquiries and complaints requiring management-level escalation.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Reviewed completed work to verify consistency, quality, and conformance.
Senior Workers' Compensation Claims Adjuster
State Compensation Insurance Fund, SCIF
Stockton, CA
04.2017 - 08.2022
- Handled complex workers' compensation claims, including those involving multiple jurisdictions and laws.
- Analyzed medical records to determine compensability of claims.
- Prepared detailed reports for review by senior management.
- Developed strategies to resolve disputes between employers and employees over workers' compensation claims.
- Negotiated settlements with claimants, attorneys, and other parties involved in the claim process.
- Reviewed benefit payments to ensure accuracy and compliance with applicable regulations.
- Drafted legal documents such as pleadings, motions, briefs, and appeals for use in court proceedings.
- Provided expert testimony at hearings regarding workers' compensation cases.
- Monitored changes in state regulations governing workers' compensation policies and procedures.
- Investigated fraud allegations related to workers' compensation claims.
- Facilitated communication between injured employees, employers, insurance carriers, attorneys, physicians, rehabilitation providers, and other stakeholders throughout the claims process.
- Maintained accurate records of all case activities using specialized software programs.
- Coordinated with medical professionals regarding treatment plans for injured employees.
- Determined liability, compensability, and benefits due on each claim.
- Input claim information and payments into company database.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
- Investigated potentially fraudulent claims with focus on thoroughness, quality, and cost control.
- Analyzed information gathered by investigations and reported findings and recommendations.
- Communicated with reinsurance brokers to obtain claim information for processing.
- Verified liability extent with reviews of police reports, medical treatment histories and other records.
- Discussed current cases and issues in claim committee meetings.
Workers' Compensation Claims Adjuster
State Compensation Insurance Fund, SCIF
Stockton, CA
09.2014 - 03.2017
- 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.
- Processed benefit payments in accordance with applicable laws and regulations.
- Developed strategies to resolve complex cases within established timeframes.
- Negotiated settlements between claimants and employers or insurers when appropriate.
- Provided customer service by responding promptly to inquiries from claimants, employers, attorneys and other stakeholders.
- Collaborated with legal counsel in the preparation of documents related to litigation proceedings involving workers' compensation claims.
- Analyzed data from multiple sources to identify trends that could affect future decisions regarding workers' compensation claims.
- Calculated amounts owed to claimants and issued company checks for appropriate compensation to close claims completely.
- Communicated with medical providers, claimants, lawyers and public officials to provide invested parties with claim information and facilitate necessary participation.
- Completed continuing education courses to remain current on applicable laws and expand upon understanding of relationships between statutory requirements and company policies.
- Monitored claim progress and issued appropriate notices to maintain continued progress on claim processing and eliminate liability to company.
- Coordinated with medical professionals to arrange treatment for injured claimants and provide relevant information to medical offices regarding policy coverage and claimant work conditions.
- Determined liability, compensability, and benefits due on each claim.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
- Input claim information and payments into company database.
Workers Compensation Insurance Technician
State Compensation Insurance Fund, SCIF
Sacramento, CA
12.2008 - 09.2014
- Reviewed and updated customer information to ensure accuracy of policy data.
- Processed new applications, renewals, and changes to existing policies.
- Entered data into the computer system and generated reports as needed.
- Assisted in resolving customer inquiries regarding their policies or billing issues.
- Handled incoming phone calls from customers seeking information about their policies or asking questions about the company's services.
- Developed relationships with external vendors such as brokers and agents to facilitate efficient service delivery.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Examined claims, records and procedures to grant approval of coverage.
- Coordinated and planned investigations of claims to confirm compensability and coverage.
Office Services Supervisor
State Compensation Insurance Fund, SCIF
Sacramento, CA
09.2007 - 12.2008
- Supervised the daily operations of a large office services team, including scheduling and assigning tasks.
- Developed and implemented procedures for efficient workflow management and customer service.
- Monitored staff performance, providing guidance and feedback to ensure optimal productivity.
- Coordinated with vendors to purchase supplies, equipment, and services necessary for office operations.
- Trained new employees in office policies and procedures, as well as use of relevant software systems.
- Ensured compliance with all applicable regulations related to office services activities.
- Managed the maintenance of office equipment such as printers, copiers, fax machines.
- Reviewed employee time sheets for accuracy prior to submitting them for payroll processing.
- Prepared various documents such as memos or letters using word processing applications.
- Reviewed incoming mail ensuring proper distribution among staff members according to their responsibilities.
- Directed and oversaw office personnel activities.
- Conducted staff performance evaluations to monitor progress and individual skills.
- Managed office inventory and placed new supply orders.
- Maintained impeccable office organization to support efficiency, professionalism and performance objectives.
- Handled scheduling and managed timely and effective allocation of resources and calendars.
- Delegated work to staff, setting priorities and goals.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Discussed job performance problems with employees, identifying causes and issues to find solutions.
- Issued work schedules, duty assignments and deadlines for office or administrative staff.
- Recruited, interviewed and selected employees to fill vacant roles.
Program Technician
State Compensation Insurance Fund, SCIF
Sacramento, CA
07.2007 - 09.2007
- Compiled data from various sources into reports for analysis.
- Attended training sessions to stay up-to-date on program policies and procedures.
- Maintained accurate records of program statistics, outcomes, budgets and expenditures.
- Collaborated with other departments within the organization to ensure that all tasks were completed efficiently.
- Maintained positive working relationship with fellow staff and management.
- Assisted organizational efforts by filing, entering data and answering phones.
- Reviewed and approved vendor invoices.
- Performed accounting or financial analysis.
Office Assistant
State Compensation Insurance Fund, SCIF
Stockton, CA
02.2005 - 07.2007
- Provided administrative support to staff members, including copying and scanning documents, filing paperwork, and ordering supplies.
- Answered incoming calls in a professional manner and directed callers to the appropriate personnel.
- Performed data entry tasks into various computer systems accurately and efficiently.
- Assisted with special projects as needed by researching information on the internet or through other sources.
- Maintained an organized filing system of paper documents and electronic files.
- Organized files, developed spreadsheets, faxed reports and scanned documents to improve organizational workflow.
- Handled incoming and outgoing mail and packages, including preparation for shipping.
- Utilized office equipment such as printers, copiers, and fax machines efficiently.
- Conducted research and compiled data for reports and projects.
- Maintained confidentiality of sensitive information and documents.
- Conducted data entry tasks with a high level of accuracy and efficiency.
- Copied, sorted and filed records of office activities and business transactions.
- Collected and entered payment data into system, maintaining complete confidentiality and accuracy.
- Developed organizational filing systems for confidential customer records and reports.
- Sorted and distributed incoming mail, dispersing to appropriate departments and personnel.
Education
Some College (No Degree) - Automotive Engineering
Universal Technical Institute
Glendale, AZSkills
- Investigation documentation
- Settlement management
- Workers' compensation claims
- Claims file documentation
- Compensation and benefits
- Policy and procedure management
- Administering claims
- Litigation Management
- Claims analysis
- Multitasking
- Work Organization and Prioritization
- Information assistance
Certification
- BAT and CEU training certified.
Timeline
Senior Claim's Resolution Manager
Gallagher Bassett Services Inc.
12.2022 - Current
Senior Workers' Compensation Claims Adjuster
State Compensation Insurance Fund, SCIF
04.2017 - 08.2022
Workers' Compensation Claims Adjuster
State Compensation Insurance Fund, SCIF
09.2014 - 03.2017
Workers Compensation Insurance Technician
State Compensation Insurance Fund, SCIF
12.2008 - 09.2014
Office Services Supervisor
State Compensation Insurance Fund, SCIF
09.2007 - 12.2008
Program Technician
State Compensation Insurance Fund, SCIF
07.2007 - 09.2007
Office Assistant
State Compensation Insurance Fund, SCIF
02.2005 - 07.2007
- BAT and CEU training certified.
Some College (No Degree) - Automotive Engineering
Universal Technical Institute
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