Suzanna Kelley
Parker,CO
Summary
Seeking a position as the Claims Education Owner at Pinnacol Assurance. Dynamic individual with 18 years of insurance industry experience, primarily in workers' compensation. Hands on experience includes adjusting workers' compensation claims, mentoring team members, and training new claims representatives, with a talent for navigating challenges. Brings strong relationship-building and networking skills with a proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset with a passion for teamwork and coaching others. Committed to making meaningful contributions and advancing organizational goals.
Overview
18
18
years of professional experience
Work History
Claims Lead
Pinnacol Assurance
06.2022 - Current
- Primary responsibility is to develop team members and drive achievement of the team’s goals.
- Responsible for coaching and mentoring team members, including availability for staffing questions, reviewing claims and identifying trends and opportunities for coaching, communicating and supporting adoption of business standards and procedure changes, reviewing compensability decisions for new claims representatives, providing authority for reserves and settlement, and providing on the job training for new team members.
- Reviews metrics regularly, communicating these to the team and strategizing with team members on progress towards goals. Identifying and removing barriers to those goals.
Workers' Compensation Claims Representative
Pinnacol Assurance
04.2014 - 06.2022
- Analyzes and evaluates all evidence and facts necessary to timely admit or deny a claim under the guidelines of the Workers Compensation Act, Rules of Procedure, SB 79 and SB 218 and case law
- Determines compensability under the laws that govern the case; analyzes information from many sources to ensure that compensation is correctly determined
- Identifies and facilitates resources to optimal case management and resolution
- Recognizes early warning signs and develops strategies through the coordination and attendance of staffing to optimize case management; works with medical coordinators and utilizes other team resources to develop action plans
- Coordinates activities on questionable or denied cases with appropriate resource
- Staffs all penalty issues and applications for penalties with assigned attorney
- Works with team members to bring claims and issues to the most expedient, cost-effective resolution; provides quality customer service through effective team coordination
- Proactively adjusts assigned claims to ensure legitimate payments are made timely and efficiently; keeping policyholders and claimants informed on status.
Workers' Compensation Claim Representative
State Farm Insurance
02.2009 - 04.2014
- Responsible for investigating, evaluating, negotiating and settling workers' compensation claims
- Verify coverage, determine legal liability and extent of damage, work with attorneys, determine the need for specialized investigation, and assist in training other employees
- Served as an Inclusion Resource Counsel ambassador
- Collaborated with other departments to increase awareness and appreciation of a diverse workforce and foster a spirit of inclusiveness amongst employees
- Responsible for coordinating communication between committee members and attending meetings to discuss the role of diversity and inclusion, and strategies to positively impact the organization and align with business goals
- Served as a CSA liaison for the workers' compensation team and the CSA team to discuss any issues or concerns, and identify and address solutions and best practices to build greater consistency between units; responsible for implementing any changes within my team
- Chosen as an ECS claim steward and solicited to serve on the ECS Implementation Fire Workflow Committee to ensure a smooth transition to the new ECS claims system for the entire zone.
MPC Claim Processor
State Farm Insurance
11.2006 - 02.2009
- Processed claims assigned by management or electronic assignment, initiated payment process, assisted claim representatives, compiled data, resolved issues, and maintained knowledge of policies and procedures
- Attended outside training seminars to improve claim handling abilities and business acumen, and shared this information with team members
- Co-led a monthly customer service meeting for my team, sharing tips and best practices and celebrating customer service successes
- Chosen to lead an eMedical training course for teams at multiple offices to train employees on a new medical bill review system.
Auto Claims Service Assistant
State Farm Insurance
09.2006 - 11.2006
- Performed duties requiring office skills and procedural knowledge in support of associates handling claims such as keying data, updating files, running reports, operating office equipment, handling mail, setting up files, and answering phones.
Education
Claims Education Owner Pathway
Pinnacol Claims Leadership Pathway
10-2023
Claims Lead Pathway
Pinnacol Claims Leadership Pathway
10-2020
Bachelar of Science in Human Services and Management - undefined
University of Phoenix
Aurora, CO01.2009
High School Diploma - undefined
Heritage High School
Littleton, CO01.1998
Skills
- Strong understanding of state workers' compensation laws and regulatory compliance
- Knowledgeable with insurance policies and practices, including claim settlement and resolution procedures
- Excellent communication and customer service skills
- Good organization and time management
- Teamwork and Collaboration
- Onboarding and mentoring
- Ability to learn quickly
- Highly adaptable and flexible in a changing work environment
References
References are available on request.
Timeline
Claims Lead
Pinnacol Assurance
06.2022 - Current
Workers' Compensation Claims Representative
Pinnacol Assurance
04.2014 - 06.2022
Workers' Compensation Claim Representative
State Farm Insurance
02.2009 - 04.2014
MPC Claim Processor
State Farm Insurance
11.2006 - 02.2009
Auto Claims Service Assistant
State Farm Insurance
09.2006 - 11.2006
Bachelar of Science in Human Services and Management - undefined
University of Phoenix
High School Diploma - undefined
Heritage High School
Claims Education Owner Pathway
Pinnacol Claims Leadership Pathway
Claims Lead Pathway
Pinnacol Claims Leadership Pathway
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