Shanina Magana
Pomona,CA
Summary
Dependable worker equipped for fast-paced work and changing daily needs. Serves claimants effectively with attention to detail and hardworking approach. Seeks out opportunities to go beyond basics, and increase claimant satisfaction.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Claims Adjuster
Sedgwick Claims Management
03.2021 - Current
- Provided exceptional customer service through clear communication, empathy, and proactive problem-solving during difficult situations.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Proficient in LC4850 benefits for first responders.
- Achieved 100% on the County of Los Angeles internal audit of 2024.
Claims Adjuster
TRISTAR Risk Management
10.2019 - 03.2021
- Manages medical treatment and medical billing, authorizing as appropriate based on City of Los Angeles claims handling guidelines
- Maintains diary system for case review and document file to reflect the status and work being performed on the file
- Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns with direction from supervisor
- Achieved 100% score for TRISTARS internal audit for 2020
Claims Adjuster
York Risk Services Group
07.2019 - 10.2019
- Monitors reserve accuracy, and files necessary documentation with state agency
- Ensures claim files are properly documented and claims coding is correct
- May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
- Maintains a professional client relationships.
Claims Adjuster
TRISTAR Risk Management
01.2019 - 06.2019
- Determines compensability of claims and administer benefits, based upon state law and in accordance with established company guidelines
- Manages medical treatment and medical billing, authorizing as appropriate
- Computes and set reserves within company guidelines
- Maintains diary system for case review and document file to reflect the status of and work being performed on the file
- Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns, Involves TRISTAR loss control staff when appropriate
Claim Assistant
TRISTAR Risk Management
12.2015 - 01.2019
- Provides Administrative support for the worker's compensation department, prepares and processes benefit and medical payments on claim files as directed by the claims examiner
- Communicates pertinent claim information to the client, legal counsel, medical providers and internal claims staff.
- Developed strong relationships with claimants, vendors, and legal representatives to enhance cooperation throughout each case''s lifecycle.
Claim Assistant
Intercare Holding Insurance
08.2012 - 08.2015
- Provide administrative support for the worker's compensation department prepares request for rating from the DEU, issues subpoena for records, handle legal referrals
- Communicates pertinent claim information to the client, legal counsel, medical providers and internal claims staff, answer phone calls, take messages and responds appropriately
Receptionist
Intercare Holdings
06.2006 - 08.2012
- Streamlined front desk operations for increased efficiency by effectively managing phone calls, emails, and walk-in clients.
- Maintained a well-organized reception area with updated materials, contributing to a welcoming environment for visitors.
- Handles Legal calendar, subpoenas, Fed-x and UPS.
- Supported office efficiency by performing clerical tasks such as data entry, photocopying, scanning, and faxing documents.
Skills
- Caseload Management
- Best Practices Implementation
- Workers' compensation claims
- Claims file documentation
- Report and Records Review
- Microsoft Office Expert
- Settlement Skills
Certification
- SIP -2023
Timeline
Claims Adjuster
Sedgwick Claims Management
03.2021 - Current
Claims Adjuster
TRISTAR Risk Management
10.2019 - 03.2021
Claims Adjuster
York Risk Services Group
07.2019 - 10.2019
Claims Adjuster
TRISTAR Risk Management
01.2019 - 06.2019
Claim Assistant
TRISTAR Risk Management
12.2015 - 01.2019
Claim Assistant
Intercare Holding Insurance
08.2012 - 08.2015
Receptionist
Intercare Holdings
06.2006 - 08.2012
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