Tanya Spears
Bakersfield,California
Summary
Experienced Senior Claims Adjuster professionally handles moderate to complex workers' compensation claims for customers. Adept at working directly with customers and providing guidance throughout the claims process. Committed to successfully managing a complex and diverse caseload and ensuring each party is satisfied with the outcome.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Workers' Compensation Senior Claims Examiner
Sedgwick CMS
Concord, CA
09.2020 - Current
- Handle assigned case load of 120+ medium/high complexity claims
- Accurately calculated and issued benefits timely
- Establish litigation strategies while managing costs and expenses
- Successfully negotiate and settle claims within given authority
- Investigate workers' compensation claims to determine eligibility and extent of coverage.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
- Discussed current cases and issues in claim review meetings.
Auto Claims Representative
Automobile Club of Southern California
Bakersfield, California
04.2019 - 09.2020
- Provided excellent customer service to claimants throughout the claims process.
- Investigated and analyzed auto insurance claims to determine validity, accuracy, and coverage.
- Researched and verified insurance policy coverage.
- Communicated with team members, policyholders, claimants and witnesses by telephone, email, and written correspondence to gather facts of loss to aid in claim resolution.
- Determined liability based on facts gathered from investigations.
Workers' Compensation Claims Specialist
State Farm
Bakersfield, California
05.2005 - 04.2018
- Handled assigned case load of moderate to complex indemnity claims
- Investigated and evaluated workers' compensation claims to determine eligibility, coverage and appropriate benefits.
- Interpreted state regulations regarding workers' compensation insurance coverage for employers.
- Maintained accurate records of all claims including status updates, payment histories and other pertinent information.
- Monitored progress of pending cases through completion according to established timelines.
- Collaborated with legal counsel on cases involving disputed or denied claims.
Education
Bachelor of Science - Health Care Administration
California State University - Long Beach
Long Beach, CA05-1999
Skills
- Time Management Abilities
- Attention to Detail
- Organizational Skills
- Multitasking
- Relationship Building
- Decision-Making
- Problem-Solving Aptitude
- Excellent Communication
Certification
- SIP certification
- IIA3 designation
- INS designation
References
References available upon request.
Timeline
Workers' Compensation Senior Claims Examiner
Sedgwick CMS
09.2020 - Current
Auto Claims Representative
Automobile Club of Southern California
04.2019 - 09.2020
Workers' Compensation Claims Specialist
State Farm
05.2005 - 04.2018
Bachelor of Science - Health Care Administration
California State University - Long Beach