Tina Owen
WC Adjuster
Clovis,CA
Summary
Claims Examiner with deep knowledge of WC claims industry. Solid abilities in developing objectives and strategies to settle WC claims. Excellent skills compiling, coding, categorizing and auditing information to process claims.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Claims Analyst
Armstrong And Associates
Woodland, CA
12.2019 - Current
- Maintained strict confidentiality with all personal data as per company guidelines.
- Identified key areas not performing well and implemented effective, new processes.
- Viewed reports regularly to make sure processing was conducted efficiently.
- Prepared claims through careful research.
- Interacted with clients and employees, which helped cultivate positive working relationships.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
WC Adjuster
AIMS
Fresno, CA
06.2016 - 12.2019
- Examined claims forms and other records to determine insurance coverage.
- Answered questions posed by insured and attorneys.
- Investigated claims involving potential and suspected fraudulent activities.
- Maintained contact with claimants and attorneys to determine treatment status.
- Partnered with legal counsel on litigation cases.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
- Paid benefits timely to prevent penalties.
- Issued all DWC notices timely.
- Maintained daily diaries and work flow.
WC Analyst, Senior Analyst
Fresno Unified School District
Fresno, CA
06.2007 - 06.2016
- Monitored checks, bills, work flow, letters daily
- Provided timely benefits and state mandated forms
- Worked closely with all departments for modified duty employees and modified duty counts
- Issued checks and vouchers for employees
- Worked closely with attorneys, QME's, EAMS and WCAB
- Attended ADA meetings
- Trained co-workers bill review
- Ordered supplies for department
- Maintained records for storage
WC Intake Examiner
Zenith Insurance Company
Fresno, CA
12.2005 - 06.2007
- Maintained high standards of customer service by building relationships with clients.
- Responded to customer calls swiftly to resolve issues and answer questions.
- Determined client needs and financial situations by listening and scheduling fact-finding appointments.
- Displayed consistent, positive attitude towards customers, peers and other personnel, even during high-stress situations.
- Scheduled fact-finding appointments and consultations to determine client needs and overall financial situations.
- Maintained all new claims and processed within 24 hours by gathering all information from employer, injured worker and doctors office
- Investigated claims for lost time, fraud and OSHA reporting
WC Bill Review Supervisor IV
Liberty Mutual Insurance
Fresno, CA
06.1990 - 09.1998
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Evaluated employee performance and coached and trained to improve weak areas.
- Handled customer complaints, resolved issues and adjusted policies to meet changing needs.
- Maintained compliance with company policies, objectives and communication goals.
- Set overall vision and provided team leadership.
- Interviewed, hired and trained new employees for production positions.
- Identified individual employee's unique work styles and adapted management methods.
- Performed annual evaluations and reviews for large staff of employees.
Education
High School Diploma -
McLane High School
Fresno, CA06.1989
Skills
- Resolving Complex Issues
- Employee Timesheet Processing
- HIPAA Compliance
- Report and Records Review
- Reserves Adjustment
- Team Training
- Reserves Recommendations
- Fraudulent Claims Investigation
- Administering Claims
- Document Workflow
- Settlement Negotiation
- Claims Evaluations
- Claim Form Analysis
Certification
Self Insurance Administrators Certificate 2006
WCCA
WCCP
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Claims Analyst
Armstrong And Associates
12.2019 - Current
WC Adjuster
AIMS
06.2016 - 12.2019
WC Analyst, Senior Analyst
Fresno Unified School District
06.2007 - 06.2016
WC Intake Examiner
Zenith Insurance Company
12.2005 - 06.2007
WC Bill Review Supervisor IV
Liberty Mutual Insurance
06.1990 - 09.1998
High School Diploma -
McLane High School
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