Sonia Gomez
Clewiston,FL
Summary
I am looking for a position that allows me to best utilize my thirty-two years of experience as a Legal/Senior Workers' Compensation Adjuster with lost time litigation, handling highly complex claims. Skilled in navigating insurance claims and providing thorough investigations to ensure fair settlements. I have experience coordinating with legal teams, policyholders, and insurance companies to manage claims efficiently. Known for strong analytical skills, ability to interpret policy details accurately, and effective communication that results in resolved disputes.
Overview
32
32
years of professional experience
Work History
Legal Workers' Compensation Adjuster
Johns Eastern
Sarasota, FL
04.2022 - Current
- Investigate workers' compensation claims and evaluate the facts to determine coverage and liability.
- Negotiate settlements in order to resolve disputes quickly and efficiently.
- Determine compensability of claims according to state laws, regulations, policies and procedures.
- Monitored changes in legislation pertaining to workers' compensation policies.
- Conducted interviews with claimants, employers, medical providers and witnesses to obtain information related to a claim.
- Calculated benefits payments due based on analysis of wage data, medical reports and other criteria.
Senior Resolution Manager
Gallagher Bassett Services Inc.
Fort Myers, FL
12.1992 - 04.2022
- Reviewed relevant documents such as contracts, invoices, purchase orders, prior to taking any action related to dispute resolution matters.
- Issue surveillance when needed facilitating the approved vendor SIU listing.
- Determine case values for potential settlement through detailed research and case study and adjust reserves for probable exposure
- Submit all appropriate federal documents and assure all state forms are completed and submitted in a timely and efficient manner.
- Work closely with defense counsel on litigated files
- Identify subrogation potential and place all parties on notice of recovery.
- · Verify the nature and extent of the injury, loss or recovery, by conducting a thorough investigation obtaining recorded statements of those involved including witnesses and obtain medical records of any injured parties. Conduct site investigations when necessary.
- Recovery of money owed to the City/County due to negligence of others through subrogation, filing for restitution up to and including legal proceedings in an effort to recover funds.
Education
State of Florida
Skills
- Litigation Support
- Litigation resolution
- Claims reviewing
- Case Management
- Case settlement abilities
- Interpreting coverage
- Customer Service
- Positive Attitude
- Excellent Communication
- Time management abilities
- Problem Resolution
- Professional Demeanor
- Interpersonal Relations
- Bilingual-Fluent in Spanish
Timeline
Legal Workers' Compensation Adjuster
Johns Eastern
04.2022 - Current
Senior Resolution Manager
Gallagher Bassett Services Inc.
12.1992 - 04.2022
State of Florida
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