Stephanie Pickford
Round Rock,TX
Summary
Seasoned insurance specialist with 18 years of experience and strong problem-solving abilities. Proven track record of expertly managing high caseloads in fast-paced environments. Organized, driven, and adaptable professional with exceptional interpersonal skills.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Claims Specialist
Insurance Company of the West
Round Rock, TX
04.2016 - Current
- Manage compensability and benefits for claims of varying severity levels, including catastrophic and death claims.
- Conduct quarterly claim reviews for major dedicated accounts.
- Collaborate with cross-functional teams to develop strategic action plans for swift resolution of open claims.
- Consistently meets company standards while managing a high volume of claims.
- Maintained precise reserves by consistently adapting them to reflect evolving exposure events.
- Ensured delivery of top-notch claims management services to s injured workers, policyholders, medical providers, and agents.
- Provide outstanding service to build and maintain strong customer relationships.
- Recovered costs through identification and pursuit of subrogation opportunities.
- Manage litigation issues by strategically staffing defense counsel.
- Manage claims for Texas and Oklahoma.
- Participate in training programs to ensure compliance with licensing requirements.
- Evaluated claims for potential fraud and took appropriate actions.
Claims Examiner
Employers Insurance Company
Austin, TX
04.2006 - 04.2016
- Reviewed and investigated claims for validity.
- Managed short-term and long-term claims efficiently
- Ensure compliance with state regulations and statutory requirements.
- Managed desk efficiently in a high-speed work environment.
- Built solid connections with injured workers, employers, agents, and teammates.
- Initiated benefits timely and accurately.
- Maintained oversight of medical records to guarantee alignment with Official Disability Guidelines for treating compensable injuries.
- Collaborated with legal experts to resolve litigated matters.
- Achieved claim resolution by effectively utilizing Peer Reviews, Designated Doctor evaluations, AOE/COE investigations, and sub-rosa investigations.
- Collaborated with Underwriting and Risk Management departments to enhance customer service.
Education
Bachelor of Science - Health Care Services
University of Phoenix
Phoenix, AZ06-2006
Skills
- Customer Engagement
- Organization and Prioritization
- Adaptability and Flexibility
- Regulatory compliance understanding
- Strategic Decision-Making
- Continuous Improvement
- Excellent Communication
- Collaborative Teamwork
Certification
- TX Workers Compensation License 03/07
- OK Workers Compensation License 04/08
- All Lines TX License 03/11
- NV Workers Compensation License 01/24
Accomplishments
- Agency Partner Customer Service - Super Nova Award 2018
- Recipient of three Executive Leadership Awards for exceptional performance 2019/2022 /2023
- Performance Based Oversight - High Tier Level 2020
- SIU Fraud Recognition 2022
- Subrogation Recovery $216,158.97 in 2023
- Provided PBO training to aid team in readiness for state audit 2023
References
References available upon request.
Timeline
Claims Specialist
Insurance Company of the West
04.2016 - Current
Claims Examiner
Employers Insurance Company
04.2006 - 04.2016
Bachelor of Science - Health Care Services
University of Phoenix
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