Stella Sayers
Riverside,CA
Summary
Acquisition of Workers' Compensation with opportunity to form a strong foundation for growth and experience, utilizing my superior adaptability, comprehension and technical abilities Responsible Senior Claims Adjuster with experience performing detailed investigations and researching issues. Skilled at interpreting laws, evaluating facts, inspecting damage and analyzing case facts. Handles over 120 caseloads per month and provides exceptional customer service to policyholders.
Overview
23
23
years of professional experience
Work History
SR Claims Examiner
SEDGWICK CMS
03.2013 - Current
- Manage all aspects of National Insurance Carrier account to ensure cost effective claims resolution
- Utilized effective cost containment practices to reduce litigation expenses
- Investigate claims to determine compensability, evaluate and analyze liability and damages, reserve appropriately
- Identify and pursue early resolution strategies
- Educate client as it relates to California jurisdictional issues
- Streamlined claims processing by implementing efficient workflow procedures.
- Collaborated with legal counsel on complex claims, ensuring compliance with regulatory guidelines.
- Mitigated company risk by identifying fraudulent activities and implementing preventative measures.
- Prepared detailed reports on claim activity for management review, highlighting areas for improvement.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Handled Contribution desk, Future Medical desk and Lien desk from 2015 - 2019. Negotiated and resolved contribution with co-defendants, negotiated their demands for resolution. Negotiated liens with lien claimants, issued lien payments, requested and obtain lien representatives for lien conferences and maintained the future medical care files, updated the files handled medical requests
Claims Examiner / SR Claims Examiner
YORK RSG
02.2008 - 03.2013
- Handle all levels of claims from non-litigated to high exposure/life pension claims
- Work with client in a team environment to mitigate exposure
- Investigated & ascertained claim compensability, in addition to attending continuing education workshops
- Utilized effective cost containment practices to reduce litigation expenses
- Administered disability payments, coordinated care with medical provider offices & processed necessary referrals with panel vendors
- Review all medical, diagnostic, and specialist reports in order to determine whether the claim will be accepted, denied or delayed benefits, keeping in mind the time frame allotted for completion, requests, objections, discovery, and decisions within the Workers' Compensation Labor Code.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
SR Claims Examiner
Gallagher Bassett
04.2007 - 02.2008
- Investigate new claims for compensability through background checks including index
- Conduct in-house investigation on new set up claims to determine AOE/COE
- Administer all compensable benefits within the Workers Compensation Law of California
- Coordinate return to work for claimants by providing medical status to the client
- Investigate subrogation potential and recovery to minimize liability
- Developed and implemented strategies with Defense Attorneys to resolve claims
- Continued education for update on new laws and issues
- Conducted field investigations and recorded statements for delayed and catastrophic claims
- Negotiated settlements with applicant attorneys, WCAB and unrepresented injured workers
- Advised and updated employers/special accounts through meetings and detailed status reports.
- Streamlined claims processing by implementing efficient workflow procedures.
- Reduced claim resolution time by conducting thorough investigations and timely decision making.
Claims Examiner / SR Claims Examiner / Claims Assistant/MO
SCRMA
01.2001 - 01.2007
- Set up claims accordingly; make 3 -point contacts to determine if indemnity or medical only
- Determine whether claim is delayed, or denied
- Develop periodic plans of action on claims, adjust reserves on claims and move claims towards resolution to ultimate closure
- Negotiate settlement of claims, negotiate liens with providers
- Participate in MSC's telephonically; meet with clients periodically for file reviews
- Strict adhesion to state workers' compensation labor codes and case law
- Medical case management; Coordinate and set medical-legal evaluations
- Investigate claims to determine compensability, evaluate and analyze liability and damages, reserve appropriately
- Report to Excess every 3 months to report files that have exceeded the threshold
- Review and pay bills accordingly
- Send all medical requests to Utilization Review
- Keeping in mind the time frame allotted for completion, requests, objections, discovery, and decisions within the Workers' Compensation Labor Code.
Education
Paralegal course -
UCR Extension
01.2024
Bachelors in Arts for Liberal Studies -
University of La Verne
01.2009
Skills
- Claims Analysis
- Investigation Techniques
- Litigation Management
- Policy Interpretation
- Decision Making
- Conflict Resolution
- Attention to Detail
- Time Management
- Organizational Skills
- Adaptability
- Reserves Management
- Regulatory Compliance
- Fraud Detection
Languages Skills
Bilingual Spanish and English, both written and verbal
Professional
Certificate of Achievement in Self-Insurance Administrator's Examination, 11/6/04, CA Claims Designation, WCCA
Bilingual in Spanish, Complete Paralegal program in 2024.
I am Central American and grew speaking Spanish. I took Spanish classes in college and graduated with a Minor in Spanish. I enrolled in a Translation course at UCR extension and completed the program. I then worked as a freelance interpreter for 5 years mainly in workers' compensation. Currently, a portion of my caseload is Spanish speaking/monolingual claimants.
I am currently enrolled in a Paralegal Program through UCR Extension and have 3 classes left to obtain my Certification.
Languages
Spanish
Native or Bilingual
Timeline
SR Claims Examiner
SEDGWICK CMS
03.2013 - Current
Claims Examiner / SR Claims Examiner
YORK RSG
02.2008 - 03.2013
SR Claims Examiner
Gallagher Bassett
04.2007 - 02.2008
Claims Examiner / SR Claims Examiner / Claims Assistant/MO
SCRMA
01.2001 - 01.2007
Paralegal course -
UCR Extension
Bachelors in Arts for Liberal Studies -
University of La Verne
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