TERRI DURAN
Phoenix,AZ
Summary
Skilled and Knowledgeable Senior Workers' Compensation Claims Specialist with 20+ years in Claims specializing in California Jurisdiction. Solid abilities in developing objectives and strategies to settle Workers' Compensation claims. Excellent skills compiling, coding, categorizing and auditing information to process workers' compensation claims. Meticulous in providing consistent and excellent customer service, computer skills, and office duties. Adapt quickly to new and evolving environments.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Senior Workers' Compensation Claims Specialist
CCMSI
07.2014 - Current
- Actively manage and adjust 115 plus Lost time / Litigated claims for California Jurisdiction by investigating and moving claims to resolution.
- Directing and assisting with medical treatment and distributing compensation benefits.
- Demonstrate proper claims handling within authority.
- Identify and remove any obstacles to ensure highest quality claims outcomes.
- Identify cases in need of medical management
- Perform thorough reviewed of all medical documents in order to monitor cases for continuation of benefits, termination, and return to work.
- Work with defense attorneys when applicable to discuss strategy of resolution of litigated claim(s)
- Develop Reserves according to client best practices
- Calculate wages for lost time benefits
- Deliver exceptional customer service to client, providers, and claimants by clearly communicating information.
- Work up files and settle files
- Inspire and motivate other claim adjusters and staff
- Used to Supervise, asst, train, mentor other California Adjusters on the team to ensure consistency, develop strengths and improve weakness.
- Successfully conduct monthly claim reviews with client to keep them up to date about open claims and claim strategies.
Senior Workers' Compensation Claims Adjuster
Lumbermen's Underwriting Alliance (LUA)
03.2013 - 06.2014
- Manage and investigate a case of up to 150 lost time/litigated California Workers' Compensation Claims.
- Performed claim processing which included investigation of claims, determination of compensability and setting reserves on reported claims based on injury type and treatment recommendation.
- Conducting quarterly claim reviews with all clients to keep them up to date of their open litigated/lost time claims and develop strategy of potential early resolution.
- Provide temporary disability payments and monitor cases for continuation of benefits, termination of benefits and return to work.
- Work with defense counsel on litigated files by setting up depositions and attempting early settlements. Pay timely settlements orders.
- Coordinate with vendor referrals and utilize UR to review for medical necessity.
- Ensure Claim files are documented properly
Work Comp Claims Adjuster III
Sedgwick
07.2010 - 03.2013
- Manage and investigate high volume of Medical Only/lost time/litigated within 10 Midwest States and California Workers' Compensation Claims.
- Performed claim processing which included investigation of claims, determination of compensability and setting reserves on reported claims based on injury type and treatment recommendation.
- Conducting quarterly claim reviews with all clients to keep them up to date of their open litigated/lost time claims and develop strategy of potential early resolution.
- Provide temporary disability payments and monitor cases for continuation of benefits, termination of benefits and return to work.
- Work with defense counsel on litigated files by setting up depositions and attempting early settlements. Pay timely settlements orders.
- Coordinate with vendor referrals and utilize UR to review for medical necessity.
- Ensure Claim files are documented properly
- Obtained Residential Minnesota Workers' Compensation License through exam 2010.
Cali Preliminary Notice Verifier/Medical Lien Pro
Asset Research Services Inc
12.1994 - 07.2010
- California Preliminary Notice Verifier: Process construction preliminary notices for large clients based on California and process medical liens to record with state.
- Gather and verify information from subcontractors, general contractors, lenders-banks, bond companies, city/county permits, and title companies to process preliminary notices within 20 days of material sale. Document files with deeds, permits, and lien information. Ownership searches with real quest, data quick and courthouse filing through title companies.
- Non-payment of material sales. file liens on property and record documents with title companies.
- Communicate with clients on time frames and process procedures to move files.
- Medical Lien Processor: Obtain documents from insurance companies in California that payments have not been made by work comp and start lien process of attempting to negotiate amounts and resolving amount before filing liens.
Education
No Degree - Medical Terminology/Reading of Medical Reports
Kaplan University
Eden Prairie, MNNo Degree - Occupational Health Medical Assistant
Maricopa Community Colleges - Mesa Community College
Mesa, AZHigh School Diploma -
New Prague Senior High School
New Prague, MNSkills
- Self-motivated and motivator
- Strong verbal communication
- Strong written communication
- Highly Driven Individual
- Work Ethics & Professionalism
- Customer Service Management
- Trustworthy Team Leader
- Problem Solver
- Organized
- Communicator
- Goal Setter
- Dependable and Responsible
- Time Management
- Flexible and Adaptable
- Relationship Building
Certification
- Certified California Workers' Compensation - 160 hours completed 02/12/2011 (continued education yearly)
- Complete and Obtain Arizona License (currently in process)
Timeline
Senior Workers' Compensation Claims Specialist
CCMSI
07.2014 - Current
Senior Workers' Compensation Claims Adjuster
Lumbermen's Underwriting Alliance (LUA)
03.2013 - 06.2014
Work Comp Claims Adjuster III
Sedgwick
07.2010 - 03.2013
Cali Preliminary Notice Verifier/Medical Lien Pro
Asset Research Services Inc
12.1994 - 07.2010
No Degree - Medical Terminology/Reading of Medical Reports
Kaplan University
No Degree - Occupational Health Medical Assistant
Maricopa Community Colleges - Mesa Community College
High School Diploma -
New Prague Senior High School
- Certified California Workers' Compensation - 160 hours completed 02/12/2011 (continued education yearly)
- Complete and Obtain Arizona License (currently in process)
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