Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Sandra Schad

Fulton,NY

Summary

Experienced Examiner trained in all aspects of Workers Compensation claims handling. Highly trained with over 20 years of investigating, managing, litigation, and settling claims. High-level negotiation skills in resolving claims to the satisfaction of all involved parties. Analytical thinker and innovative problem solver.

Great Customer Service communication skills. Energetic and enthusiastic insurance professional motivated by details to succeed in fast-paced and deadline-driven professional environment. Comprehensive knowledge of WC claims handling. Proficient in executing claims transactions and applying settlement protocols to foster timely, fair and accurate claims processing.

Overview

20
20
years of professional experience

Work History

Claims Examiner

Sedgwick
Syracuse, NY
08.2018 - 08.2024
  • Provided excellent customer service, resolving clients' and claimants' concerns and queries promptly.
  • Analyzed information from claimants, witnesses, and medical professionals to make informed decisions.
  • Evaluated evidence with ultimate goal of creating positive outcomes for client's claims.
  • Processed claims payments and denials in accordance with company procedures, client special handling, and jurisdictional laws.

  • Developed a detailed understanding of the company's policies and procedures related to claim processing and payment determination.
  • Communicated with personnel and legal counsel on claims involving litigation.
  • Managed workloads efficiently by prioritizing tasks based on urgency or importance.
  • Entered claim transactions, payments, reserves and other documentation.

Account Claims Representative II

PMA Management Corp
Dewitt, NY
11.2007 - 11.2017
  • Reduced loss ratios through fair and prompt processing of claims.
  • Obtained relevant evidence and information regarding suspicious claims.
  • Interviewed claimants, medical specialists and employers to determine important  claim information.
  • Managed a case load of  approximately 150 claims normally.
  • Attended numerous anti-fraud training's, conferences, client SIU training's and industry seminars.
  • Investigated any potentially fraudulent claims with a focus on thoroughness, quality and cost control.
  • Developed connections with local fraud bureaus, district attorneys' offices and professional associations.
  • Contacted injured parties and legal representatives to negotiate final settlements for claims.
  • Kept up-to-date on changes with regard to New York EDI requirements and 2007 WC Reform.
  • Obtained all necessary information to complete proper evaluation of injury claims costs.
  • Completed required investigations on referred files in a timely manner, with timely first pay benefits.

    • Claims Adjuster

    CNA Insurance Co
    Dewitt, NY
    11.2005 - 06.2006
    • Interviewed claimants, medical specialists and employers to determine pertinent claim information.
    • Decided on compensability of investigated claims. Accepted cases were turned over to another team. Contested cases remained on my case load to resolve litigated issues.
    • Investigated multi-states including Connecticut, New Hampshire, Massachusetts, Vermont and New York.
    • Obtained relevant evidence and information regarding suspicious claims.
    • Investigated any potentially fraudulent claims with a focus on thoroughness, quality and cost control.

    Claims Representative

    Gallagher Bassett
    North Syracuse, NY
    03.2004 - 11.2005
    • Interviewed claimants, medical specialists and employers to determine pertinent claim information.
    • Identified and collected evidence and determined its value to a specific claim.
    • Contacted injured parties and legal representatives to negotiate final settlements for claims.
    • Worked closely with defense counsel on litigated claims.
    • Obtained all necessary information to complete proper evaluation of injury claims.
    • Completed required investigations on referred files in a timely manner.
    • Met all deadlines, timely.

    Claims Manager III

    Liberty Mutual Ins Co
    Dewitt, NY
    06.1993
  • Interviewed claimants, medical specialists and employers to determine pertinent claim information.
  • Managed a case load of 170 cases.
  • Attended numerous anti-fraud training's, conferences, client SIU training's and industry seminars.
  • Conducted interviews, gathered detailed information and completed claims decisions.
  • Investigated any potentially fraudulent claims with a focus on thoroughness, quality and cost control.
  • Mentored 6 new members of the claim staff.
  • Developed connections with local fraud bureau, attorneys' offices and professional associations.
  • Contacted injured parties and legal representatives to negotiate final settlements for claims.
  • Recommended settlement offers and negotiated same, for unrepresented claimants.
  • Kept up-to-date on changes in NY WC Law.
  • Completed required investigations on referred files in a timely manner and timely first pay benefits.
  • Reviewed data to verify the current exposure and appropriate reserves.

    • Education

    High School Diploma - English

    Altmar Parish Williamstown (APW) Central HS
    1982

    Insurance Independent Adjuster

    New York Insurance Department
    2010

    Skills

    • Claims file management processes
    • Medical terminology specialist
    • Litigation resolution
    • Insurance fraud experience
    • Strong interpersonal and communication skills
    • Workers’ Compensation Claims Specialist
    • Analytical
    • Team player
    • Decisive
    • Critical thinker
    • Interviewing techniques
    • Report writing
    • Self-directed

    Accomplishments

    • Received recognition award for several years of claims managing with NO penalties.
    • Received recognition from claims management, sales, underwriting and office manager for an extremely satisfied large account following an important claims review.
    • Acknowledged for being a strong part of a large account renewal.
    • Acknowledged for impressive claims handling for both Insurance written policies, self insured policies as well as combined (unbundled) claims policies.

    Timeline

    Claims Examiner

    Sedgwick
    08.2018 - 08.2024

    Account Claims Representative II

    PMA Management Corp
    11.2007 - 11.2017

    Claims Adjuster

    CNA Insurance Co
    11.2005 - 06.2006

    Claims Representative

    Gallagher Bassett
    03.2004 - 11.2005

    Claims Manager III

    Liberty Mutual Ins Co
    06.1993

    High School Diploma - English

    Altmar Parish Williamstown (APW) Central HS

    Insurance Independent Adjuster

    New York Insurance Department

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