Susan Thomas
Raleigh,NC
Summary
Workers compensation specialist focused on investigation, reserving, settlement negotiation, and recovery analysis for complex and catastrophic claims. Brings strong command of litigation support, Medicare Set-Aside requirements, CAT medical case management, and professional communication to support efficient claim resolution.
Overview
1
1
Certification
27
27
years of professional experience
Work History
HR Technician II
NC Division of Juvenile Justic and Delinquency Prevention Department of public Safety
08.2026 - Current
- Provided human resources support by processing and maintaining employee records, personnel actions, payroll documentation, benefits information, and employment transactions to ensure compliance and accuracy. Serve as a resource to employees, managers, and HR staff by responding to inquiries and providing guidance on policies, procedures, and HR processes.
- Process appointments, promotions, transfers, separations, salary changes, leave actions, and other personnel transactions accurately and timely.
- Maintain confidential employee files and ensure HR records are complete, accurate, and compliant with applicable policies and regulations.
- Assist with recruitment, onboarding, employment verification, background checks, and new-hire documentation.
- Respond to employee and management inquiries regarding benefits, payroll, leave, policies, procedures, and personnel matters.
- Review and enter HR data into human resources information systems (HRIS), ensuring data integrity and confidentiality.
- Resolved discrepancies involving personnel records, payroll, benefits, and employment transactions, enhancing data integrity and employee satisfaction.
- Interpret and apply HR policies, procedures, and applicable federal, state, and organizational requirements.
- Collaborated with HR professionals, payroll, benefits, and management to address and resolve employee and administrative issues promptly, fostering effective communication across departments.
Senior Resolution Manager
Gallagher Bassette/Cannon
04.2025 - 07.2025
- Investigated and managed 25 TPA accounts in Florida, overseeing a caseload of 125-150 complex indemnity and catastrophic claims across various sectors including trucking, construction, and class actions.
- Maintained detailed records of hearings, responses to petitions, and mediations while collaborating with legal counsel to supervise litigation and manage adherence to case management guidelines, achieving settlements on complex claims exceeding $1 million.
- Review documents/mail, analysis, three-point contacts, recorded statements, and investigation of the information, to determine the compensability for the loss, based on state law and in accordance with established Company guidelines and a timely manner and achieving excellent customer service results.
- Evaluate subrogation/pursuing any recovery potential, setting appropriate reserves based on client’s formats, authorize, and process payments within the authority.
- Managed 30/60/90 day diary reports and excess carrier reports, facilitating claims reviews with clients to resolve matters and authorize settlements within established guidelines while ensuring strong professional relationships.
- Contract Work due to recent move back to North Carolina and change of resident and nonresident change to be near grandchildren and took time to spend with family
Senior Workers Claims Examiner
Brentwood Claims Services
12.2024 - 03.2025
- Investigated and managed complex TPA accounts (City of Gastonia, Grady Health Systems, Henry County Schools) with a caseload of 125-150 complex indemnity and catastrophic workers' compensation claims across North Carolina, Georgia, South Carolina, Virginia, and Kentucky, while providing backup for all East Coast states.
- Reviewed documents, conducted analysis, performed three-point contacts, recorded statements, and investigated information to determine compensability of losses according to state law and company guidelines, ensuring timely responses and excellent customer service.
- Maintained 30/60/90 day diary reports and excess carriers’ reports, participated in claims reviews with clients, and resolved matters within authority for settlements up to $250,000 and excess claims over $1 million, fostering professional relationships.
- Evaluated subrogation claims to identify recovery potential., setting appropriate reserves based on client’s formats, authorize, and process payments within the authority.
- Maintained detailed logs of hearings and mediations while collaborating with legal counsel and supervising litigation.
Senior Workers Claims Examiner
Sedgwick Claims Management
11.2021 - 11.2024
- Investigated and managed large complex TPA accounts (American Airlines/PepsiCo) with a caseload of 125-135 large exposure indemnity and catastrophic workers compensation claims across North Carolina, South Carolina, and Georgia, while providing backup for all other East Coast states, including umbrella and excess claims for diverse roles such as airline stewards, pilots, and truck drivers.
- Reviewed documents and analyzed recorded statements and three-point contacts to determine compensability of losses based on state law and company guidelines, achieving timely resolution and maintaining high customer service standards.
- Evaluate subrogation/pursuing any recovery potential, setting appropriate reserves based on client’s formats, authorize, and process payments within the authority. Settling 1 plus claims.
- Maintained detailed records of hearings and mediations, supervised litigation processes, and coordinated with legal counsel and medical case management.
- Maintained 30/60/90 day diary reports and excess carriers’ reports, participating in claims reviews with clients to resolve multimillion-dollar settlements while obtaining authority approval per guidelines and fostering professional relationships.
Claim Examiner III/Senior Adjuster
Tristar Risk Management
02.2021 - 11.2021
- Investigated and managed large Complex/Large Exposure TPA accounts with a caseload of approximately 125-150 workers compensation claims across multiple states.
- Reviewed documents and analyzed claims through three-point contacts and recorded statements to determine compensation for loss in compliance with state law and company guidelines, ensuring timely resolution and high customer service satisfaction.
- Evaluate subrogation/pursuing any recovery potential, setting appropriate reserves based on client’s formats, authorizing loss and expense payments within authority.
- Maintained detailed logs of suits, arbitrations, and mediations; assigned legal counsel and managed medical case management while supervising litigation activities and coordinating with outside vendors for compliance.
- Managed 45-60-90 day diary reports and excess carrier reports, participated in claims reviews with clients, and resolved settlement matters while handling excess claims over one million, ensuring adherence to guidelines and fostering professional client relationships.
Business Development Manager
Professional Rehabilitative Options, Inc.
01.2020 - 02.2021
- Generated new business and achieved market research goals by developing guidelines and referrals for MRI, CT scans, and DME cost effectiveness, aligning efforts with corporate long-term strategic goals and negotiating contracts for products and services.
- Monitored PRO service market demands and trends, developing procedures and protocols for PRO Medical Solutions, LLC, that streamlined initial sales, scheduling, ordering, and invoicing processes.
Senior Claims Adjuster/Workers Compensation
North Carolina League of Municipalities
11.2017 - 10.2019
- Investigated and managed large complex and large exposure claims, supervised a team of adjusters, and handled lost time and medical-only workers compensation claims for local government. Recorded statements, performed interviews, reviewed medical records, accepted or denied claims, adjusted reserves, and assigned outside vendors to ensure cost-effective management of claims exceeding $75,000, including various class action and complex claims involving police officers, firefighters, truck drivers, city workers, and construction personnel.
- Resolved complex claims while ensuring cost-effectiveness and compliance with Medicare Set Aside requirements, exercising settlement authority of $250,000 or greater on excess claims exceeding one million.
- Facilitated negotiation of settlements to resolve claims effectively and attended mediations, hearings, and depositions.
- Processed payments for Temporary Total and Permanent Partial benefits to injured workers.
- Wrote all corresponding legal letters and responses to legal counsel.
- Filed all Formal Forms with North Carolina Industrial Commission.
- Maintaining 30-60-90 days diaries reports, excess carriers report, participating in claims reviews with clients and resolving matters within settlements. Excess claims handling and million plus, obtaining authority approval pursuant to guidelines and maintaining a professional and excellent customer relationship.
- Overseeing scheduling education and training for CE classes
Senior Claims Adjuster/Workers Compensation
Builders Mutual Insurance Company /Aegis Administrative Services
11.2011 - 11.2017
- Investigated and managed large complex indemnity and CAT workers compensation claims across North Carolina, South Carolina, and Tennessee, including recorded statements, interviews, medical record reviews, claims acceptance/denial, reserve adjustments, and vendor assignments for cost-effective exposure, while also supporting claims in VA, FL, GA, TN, and KY.
- Resolved complex claims cost-effectively in compliance with Medicare Set Aside requirements, successfully settling large claims exceeding one million dollars.
- Negotiated settlements with claimants to resolve disputes and reach agreements, attended mediations, hearings, and depositions.
- Payments for all Temporary Total, Permanent Partial benefits, and settlement checks as they were due to injured workers, by calculating and paying compensation.
- Drafted legal letters and responses to counsel, ensuring compliance and clarity in communication.
- Filed all formal Forms with North Carolina Industrial Commission and with Tennessee Department of Labor and Workforce.
Senior Claims Adjuster/Workers Compensation
CorVel
06.2009 - 11.2011
- Managed all large complex/lost time/CAT workers compensation files for Department of Corrections claims in North Carolina, conducting interviews, reviewing medical records, accepting or denying claims, adjusting reserves, and assigning outside vendors for cost-effective exposure management, handling DOC officers, truck drivers, and excess claims.
- Payments for all Temporary Total, Permanent Partial benefits, and settlement checks as they were due to injured workers, by calculating and paying compensation.
- Negotiated settlements and attended mediations, hearings, and depositions.
- Resolved complex claims within Medicare Set Aside requirements, filed formal forms with North Carolina Industrial Commission and Tennessee Department of Labor and Workforce, corresponded with Attorney General on state claims, and provided settlement recommendations for state budgets through legal letters and responses.
- Review documents/mail, analysis, three-point contacts, recorded statements, and investigation of the information, to determine the compensability for the loss, based on state law and in accordance with established Company guidelines and a timely manner and achieving excellent customer service results.
- Evaluate subrogation/pursuing any recovery potential, setting appropriate reserves based on client’s formats, authorize, and process payments within the authority.
- Maintained detailed logs of hearings, responses to petitions, and mediations; collaborated with legal counsel to supervise litigation and investigate large complex claims, ensuring adherence and cost containment, and negotiated settlements for claims exceeding one million.
- Maintaining 30/60/90 days diaries reports, Excess Claims handling and reports, Excess claims settlement of million plus, participate in claims reviews with the clients to resolve the matters and settlements within the authority up to pursuant to guidelines and maintaining a professional customer relationship.
Senior Claims Adjuster/Workers Compensation
KeyRisk Management Services Company
04.2007 - 06.2009
- Effectively investigate and Manage all Large Lost Complex/Large Exposure/CAT workers compensation files for the Department of Corrections workers compensation claims in North Carolina, recorded statements, performing interviews, reviewing medical records, accepting, or denying claims, adjusted reserves for exposure, and assigned outside vendors for cost effectiveness of the exposure. Payments for all Temporary Total, Permanent Partial benefits, and settlement checks as they were due to injured workers, by calculating and paying compensation.
- Negotiated settlements and attended mediations, hearings, and depositions.
- Resolved complex claims cost-effectively, ensuring compliance with Medicare Set Aside requirements.
- Corresponded with Attorney General regarding State claims, provided settlement recommendations for state budgets, filed formal forms with North Carolina Industrial Commission and Tennessee Department of Labor and Workforce, and drafted legal correspondence.
- Review documents/mail, analysis, three-point contacts, recorded statements, and investigation of the information, to determine the compensability for the loss, based on state law and in accordance with established Company guidelines and a timely manner and achieving excellent customer service results.
- Evaluated subrogation claims to pursue recovery potential, setting appropriate reserves based on client’s formats, authorize, and process payments within the authority.
- Maintaining detailed hearings, Responses to Petitions, Mediations, and hearing logs; collaborating closely with the legal counsel, supervising litigation, investigating large Complex claims/CAT medical case management for adherence and outside vendors for cost containment, settlement of complex claims up to million plus, excess claim settlements negotiations.
- Maintained 30/60/90 day diary reports, managed excess claims handling and settlements exceeding one million, and participated in client claims reviews to facilitate resolutions within established guidelines while fostering professional relationships.
Senior Workers Compensation Adjuster
Aegis Administrative Services/Builders Mutual Insurance Company
05.2001 - 04.2007
- Investigated and managed medical-only and lost time claims for workers compensation in North Carolina and Tennessee, while providing backup for claims across VA, FL, SC, GA, MD, KY, and WVA, handling various complex claims including construction, trucking, and class action cases.
- Payments for all Temporary Total, Permanent Partial benefits, and settlement checks as they were due to injured workers, by calculating and paying compensation.
- Filed all formal Forms with North Carolina Industrial Commission and with Tennessee Department of Labor and Workforce.
- Reviewed documents, conducted three-point contacts, analyzed recorded statements, and investigated information to determine compensability for losses based on state law.
- Evaluate subrogation/pursuing any recovery potential, setting appropriate reserves based on client’s formats, authorize, and process payments within the authority.
- Maintained detailed hearing logs, responses to petitions, and mediations, while collaborating with legal counsel and supervising litigation for complex claims, ensuring adherence to cost containment protocols and negotiating settlements exceeding one million, compliant with Medicare Set Aside requirements. Settlement of all complex large, and Excess of million plus claims.
- Maintained 30/60/90 day diary reports and handled excess claims settlements exceeding one million, facilitating claims reviews with clients to resolve matters and ensure compliance with guidelines while fostering strong customer relationships.
Executive Administrative Assistant
Pronto Automation Technology, Inc
10.1999 - 05.2001
- Supported president by managing secretarial and receptionist duties, ensuring efficient office operations.
- Processed insurance claims and Workers Compensation filings, maintained personnel and attendance records, and managed payroll documentation in Human Resources.
- Accounts Payable: Invoicing, all incoming bills petty cash.
- Performed various clerical duties to support office operations.: typed all company legal documents, filing and records, including work orders, and closure of files.
- Set up all credit accounts. Manufacture certificates, billing, and leasing contracts.
- Coordinated shipping and receiving operations, accurately tracking all incoming and outgoing merchandise in the system.
- Purchasing Department duties, managing all purchasing for the company needs, input purchase orders.
Education
High School Diploma -
J F Webb High School
3200 Webb School Road, Oxford NC 2756501-1987
Vance Granville Community College - Safety Education, Human Growth and Development, Composition, Access, Keyboarding, Word.
Skills
- Workers Compensation claims adjusting
- Complex/high exposure claim management
- Investigations and recorded statements
- Compensability and liability evaluation
- Medical and legal document analysis
- Settlement negotiation
- Subrogation/recovery evaluation
- Reserving and payment authorization
- Hearings, mediations, and arbitration support
- Litigation supervision coordination
- CAT medical case management oversight
- Medicare Set-Aside (MSA) requirements
- Risk management
- Diaries (30/60/90 day) and claims tracking
- Customer service and professional relationship management
- HRIS data entry and HR record maintenance
- Benefits administration and leave tracking
- Recruitment/onboarding support
- Employment verification and background checks
- Microsoft Office
- Windows
- Word/Excel
- Access (database)
- Keyboarding
- AS 400
- Lotus Notes
- QuickBooks
- PowerPoint
- Foxit
- Microsoft Teams
- Outlook
- CMS
- DfFiller integrations
- IVOS/Mitchel electronically filing systems
- Workday
- Smartsheet
- FORI
- Teams
- Multiple claims systems
- Payroll processing
- Benefits administration
- Personnel records
- Recruitment support
- Employee relations
- Policy interpretation
- Compliance tracking
- Records management
- Employment verification
- Attention to detail
- Confidentiality handling
- Professional communication
- Problem solving
- Talent acquisition
- Employee relations management
- Labor law compliance
- Employee onboarding
- Compensation analysis
- Interpersonal coordination
- Workforce planning
- Recruitment and selection
- Employment law
- Interviewing techniques
- Staff management
- Cost reductions
- Customer service delivery
- Employee engagement
- Recruitment
- Team building
- Negotiation
- Payroll administration
- Training and mentoring
- Benefits administrator
- Recruitment life cycle
- Collective bargaining
- Customer relations
- Presentation preparation
- Complex Problem-solving
- Paperwork verification
- Background checks
- Organizational development
- Job analysis
- HR policy/procedure development
- HR services
- Compensation and benefits
- Recruiting
- Data evaluation
- Conflict resolution tactics
- Benefits package preparation
- Claims investigation
- Reserving analysis
- Compensation calculations
- Litigation management
- Claims systems
- Workers compensation
- File management
- Subrogation recovery
- Benefit administration
- Clear communication
- Analytical thinking
- Negotiation skills
- Case prioritization
- Workers' compensation laws
- Examine reports
- Case coordination
- Database management
- Claims management
- Teamwork and collaboration
- Multi-Tasking Capability
- Onsite evaluation
- Liability analysis
- Decision-making
- Benefits review
- Client interviewing
- Analytical skills
- Claimant Interviewing
- Financial analysis
- Professional demeanor
- Negotiation techniques
- Relationship building
- Investigation management
- Claims settlement
- Accredited claims professional
- Computer literacy
- Rules of evidence
- Excellent communication
- Cost analysis
- Claim form analysis
- Investigation reporting
- Time management abilities
- Conflict management
- Insurance Law Understanding
- Case reporting
- Fraud identification
Certification
- North Carolina Adjuster/Property & Liability License/All Lines of Authority, North Carolina, North Carolina
- Nonresident adjuster, South Carolina, Georgia, Tennessee, Florida, Virginia, Mississippi, Kentucky, Alabama, Arkansas
- Tennessee Certified, Tennessee, Tennessee
- VA Certified, Virginia, Virginia
- Certified Builder’s Insurance Agent
- Certified Workers Compensation Professional
Notes
- No explicit personal identifiers (name, email, phone) or street address were provided in the resume text.
- Some employment date ranges were provided in partial formats (e.g., 'December 2, 2024-March 3, 2025', 'November 2021 to 11/30/24', 'June-2009-November 2011'). For ISO conversion, missing day/month components were normalized to the first/last day of the stated month/year where applicable.
Other Locations Mentioned
- Florida
- Gastonia, North Carolina
- Georgia
- Tennessee
- Virginia
- Mississippi
- Kentucky
- Alabama
- Arkansas
- South Carolina
- Maryland
- West Virginia
Personal Information
Title: HR Technician II
Timeline
HR Technician II
NC Division of Juvenile Justic and Delinquency Prevention Department of public Safety
08.2026 - Current
Senior Resolution Manager
Gallagher Bassette/Cannon
04.2025 - 07.2025
Senior Workers Claims Examiner
Brentwood Claims Services
12.2024 - 03.2025
Senior Workers Claims Examiner
Sedgwick Claims Management
11.2021 - 11.2024
Claim Examiner III/Senior Adjuster
Tristar Risk Management
02.2021 - 11.2021
Business Development Manager
Professional Rehabilitative Options, Inc.
01.2020 - 02.2021
Senior Claims Adjuster/Workers Compensation
North Carolina League of Municipalities
11.2017 - 10.2019
Senior Claims Adjuster/Workers Compensation
Builders Mutual Insurance Company /Aegis Administrative Services
11.2011 - 11.2017
Senior Claims Adjuster/Workers Compensation
CorVel
06.2009 - 11.2011
Senior Claims Adjuster/Workers Compensation
KeyRisk Management Services Company
04.2007 - 06.2009
Senior Workers Compensation Adjuster
Aegis Administrative Services/Builders Mutual Insurance Company
05.2001 - 04.2007
Executive Administrative Assistant
Pronto Automation Technology, Inc
10.1999 - 05.2001
High School Diploma -
J F Webb High School