Stacey Horban
Vacaville,CA
Summary
Detail-driven Workers' Compensation Manager with 20+ years of experience in high-exposure litigation and claims management. Expert in state labor regulations, including OSHA and ERISA compliance. Skilled in evaluating medical evidence and negotiating complex settlements to achieve optimal legal outcomes while maintaining customer satisfaction ratings.
Overview
27
27
years of professional experience
Work History
Workers' Compensation Claims Supervisor
L.WP. Claims Solutions
12.2023 - Current
- Oversaw daily operations for public entities, ensuring compliance with industry standards and regulations.
- Assisted with onboarding of new employees.
- Analyzed complex claims to determine validity and appropriate resolution strategies.
- Mentored staff, fostering skill development and enhancing team performance.
- Collaborated with cross-functional teams to resolve complex claim issues effectively.
- Consistently met deadlines under pressure while maintaining high-quality work output in a fast-paced environment.
- Improved team morale and productivity through effective communication and active listening skills.
- Streamlined claims processing workflows, improving efficiency and reducing turnaround times.
- Conducted quality assurance reviews to maintain accuracy in claims submissions.
Worker's Comp. Claims Manager
AIMS
07.2016 - Current
- Provided regular and ongoing training, development and mentoring of staff.
- Supervised all claims staff within unit for two locations.
- Conducted regular personnel performance reviews.
- Monitored and facilitated daily technical claims issues, and support to insure timely resolution of claims.
- Maintained ongoing diaries for regular file reviews.
- Provided input on delayed claims, high profile/complex claims.
- Reviewed and approved all denials.
- Performed internal audits, annual budgets and run weekly/monthly reports.
- Worked closely with clients and attends claim review meetings as needed.
- Demonstrated a thorough understanding of company policies and procedures.
- Performed weekly ADP payroll for all unit staff.
- Oversaw daily operations, ensuring adherence to safety protocols and operational guidelines.
- Streamlined workflow processes, enhancing overall efficiency in task execution.
Senior Worker's Comp. Claims Examiner
AIMS
08.2012 - 06.2016
- Provided efficient and reliable customer service.
- Made 3-point contacts within 24 hours and determine compensability or AOE/COE.
- Paid temporary disability and permanent disability benefits timely.
- Maintained a 90-day plan of action.
- Adjusted workers' compensation claims for a public entity.
- Authorized appropriate medical treatment, send authorization requests outside of my authority to utilize.
- Developed and process benefit notices and denial letters.
- Recommended litigation and negotiate claim settlements.
- Reported excess reportable claims to appropriate excess carrier.
- Monitored reserves and adjust based on exposure.
Senior Worker's Comp. Claims Examiner
York Insurance Services
08.2004 - 06.2012
- Provided efficient and reliable customer service.
- Made 3-point contacts within 24 hours and determine compensability or AOE/COE.
- Paid temporary disability and permanent disability timely.
- Examiner for indemnity claims. Specifically, Unified School Districts and public entities.
- Reported excess reportable claims to appropriate excess carrier.
- Authorized appropriate medical treatment.
- Sent appropriate benefit notices to the claimant.
- Negotiated settlements.
- Maintained ongoing diaries.
- Monitored reserves.
Worker's Comp. Claims Assistant
Tristar Risk Management
05.2001 - 08.2004
- Provided efficient and reliable customer service.
- Entered temporary disability and permanent disability benefits timely based on instructions from the index.
- Examiner for medical claims only.
- Followed up on work statuses and authorize medical care for medical only claims.
- Developed and process benefit notices and denial letters.
- Oversaw workflow processes to enhance operational efficiency across projects.
Patient Account Representative
Northbay Medical Center
09.1999 - 05.2001
- Knowledge of CPT and ICD-9 codes. Also use UB-92 and HCFA forms.
- Managed billing and aging reports for over 2500 patients a month.
- Administered HMO, PPO, Capitation, Workers Compensation, Medicare, and Self-pay accounts.
- Prepared adjustments and write-offs for capitated accounts.
- Compiled refunds for over payments.
- Managed patient account inquiries, ensuring timely resolution and customer satisfaction.
- Processed insurance claims accurately, reducing errors in billing submissions.
Claims Representative - I
Partnership Health Plan
02.1999 - 09.1999
- Processed 200 claims per day for Medi-Cal providers.
- Processed Authorizations and Referrals for Providers.
- Knowledge of all Medi-Cal forms, CIF's, and Medi-Cal codes.
- Processed and reviewed claims for accuracy and compliance with policy guidelines.
- Provided support to members regarding claim status and benefits inquiries.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
Education
A.A.S. - Computer Business Administration
Heald College
Rancho Cordova, CA01.2002
Skills
- Regulatory & Statutory Compliance
- Financial & Reserving Skills
- Medical Literacy
- Return-to-Work (RTW) Coordination
- Litigation oversight
- Claims Management Systems (CMS)
- Negotiation & Dispute Resolution
- Empathetic Communication
- Problem-solving analysis
- Valid state certification
Accomplishments
- SIP certified
- Awarded for NO absences for two-year period
- Student of the Quarter
- Deans List – 2000 (Heald College)
- 3.5 GPA
- A.A.S. – Computer Business Administration
Timeline
Workers' Compensation Claims Supervisor
L.WP. Claims Solutions
12.2023 - Current
Worker's Comp. Claims Manager
AIMS
07.2016 - Current
Senior Worker's Comp. Claims Examiner
AIMS
08.2012 - 06.2016
Senior Worker's Comp. Claims Examiner
York Insurance Services
08.2004 - 06.2012
Worker's Comp. Claims Assistant
Tristar Risk Management
05.2001 - 08.2004
Patient Account Representative
Northbay Medical Center
09.1999 - 05.2001
Claims Representative - I
Partnership Health Plan
02.1999 - 09.1999
A.A.S. - Computer Business Administration
Heald College