Sonya Nelson
DOUGLASTON,New York
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Workers' Compensation Claims Adjuster
Wright Risk Management
06.2019 - Current
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Examined claims forms and other records to determine insurance coverage.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Maintained contact with claimants and attorneys to determine treatment status.
- Identified suspicious losses and contacted manager for investigative assistance.
- Worked with private investigators and attorneys on preparation of evidence, witness statements and other documentation in preparation for trial.
- Froi-Sroi
- PPD
- Establish reserves, authorize payments & treatment within the NYS Medical Treatment Guidelines, under set authority
Medical Processing Specialist
Wright Risk Management
01.2012 - 06.2019
- Streamlined data entry processes for increased accuracy and reduced errors in documentation.
- Enhanced processing efficiency by optimizing workflows and implementing new software tools.
- Utilized established methods for data processing and analysis for consistency and accuracy.
- Assist and resolve phone calls from providers regarding billing questions.
- Accurately audit and recode medical bills using propriety bill review software in compliance with NYS Workers Compensation fee schedule.
- Great organizational skills and strong attention to detail
Education
GED -
Hempstead High School
HempsteadSkills
- Claims Investigation
- Decision-Making
- Critical Thinking
- Claims Processing
- Problem-Solving
- Payment Processing
- Time Management
- Customer service and support
- Teamwork and Collaboration
- Denied claims identification
- Attention to Detail
- Report and Records Review
Certification
- Licensed New York State Adjuster
Timeline
Workers' Compensation Claims Adjuster
Wright Risk Management
06.2019 - Current
Medical Processing Specialist
Wright Risk Management
01.2012 - 06.2019
GED -
Hempstead High School
Similar Profiles
David BrittDavid Britt
Office Manager/ Senior Relationship Manager at The Wright Risk ConsultantsOffice Manager/ Senior Relationship Manager at The Wright Risk Consultants
Nima MishraNima Mishra
Client Manager at Benefit & Risk ManagementClient Manager at Benefit & Risk Management
Anderson GrullonAnderson Grullon
Insurance Consultant at ICA Risk ManagementInsurance Consultant at ICA Risk Management
Jeannette Joma EllisJeannette Joma Ellis
Front at NAFront at NA
Ryan ReidRyan Reid
Mailroom Clerk at Sacred Heart UniversityMailroom Clerk at Sacred Heart University