Thomas Edmisten
Claims Examiner
Hacienda Heights ,CA
Summary
Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes. Astute insurance professional offering 30+ years in Workers Compensation, liabilities determination and settlement negotiation. Meticulous, systematic and highly experienced with strong case management and relationship-building abilities. Carefully manage over 200 cases per month.
Overview
32
32
years of professional experience
1
1
Certification
Work History
Claims Examiner
Tristar Risk Management LAPD Account
Alhambra , CA
06.1999 - Current
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims. Multiple year exposure to ADR MPN practice and procedure.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Interviewed claimants and witnesses to gather factual information.
- Verified insurance claims and determined fair amount for settlement.
- Researched claims and incident information to deliver solutions and resolve problems.
Senior Claims Examiner
Zurich Insurance
City of Los Angeles , CA
06.2003 - 06.2004
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Examined claims forms and other records to determine insurance coverage.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Settled multiple high dollar claims
Senior Claims Examiner
Liberty Mutual
Glendale , CA
06.2000 - 06.2002
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Examined claims forms and other records to determine insurance coverage.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Researched claims and incident information to deliver solutions and resolve problems.
- Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
- Negotiated [Type] settlement agreements to resolve disputes.
Claims Examiner
Ralphs Self Insured
Compton , CA
06.1998 - 06.2000
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Claims Examiner
CRAWFORD AND COMPANY
Los Angeles , CA
07.1996 - 06.2000
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Interviewed claimants and witnesses to gather factual information.
- Verified insurance claims and determined fair amount for settlement.
- Finalized Workers Compensation files for insurance claim payment release.
Education
Psychology
City College
PasadenaSkills
- Legal Documentation
- Customer Satisfaction
- Deductible Collection
- Reading Comprehension
- Claims Understanding
- Settlement Negotiation
- Administering Claims
- Claim Form Analysis
Certification
- Califronia Workers Compensation Self Isured Cerification - 1994 to Present
Additional Information
Excellent ability to coordinate with legal experts to produce an exceptional number of resolutions and closures
Languages
Spanish
Limited Working
Timeline
Senior Claims Examiner
Zurich Insurance
06.2003 - 06.2004
Senior Claims Examiner
Liberty Mutual
06.2000 - 06.2002
Claims Examiner
Tristar Risk Management LAPD Account
06.1999 - Current
Claims Examiner
Ralphs Self Insured
06.1998 - 06.2000
Claims Examiner
CRAWFORD AND COMPANY
07.1996 - 06.2000
Psychology
City College
- Califronia Workers Compensation Self Isured Cerification - 1994 to Present
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