Victoria Roberts
Colorado Springs ,CO
Summary
Skilled in navigating complex insurance claims and providing thorough investigations to ensure fair settlements. Have experience coordinating with legal teams, policyholders, and insurance companies to manage claims efficiently. Known for strong analytical skills, ability to interpret policy details accurately, and effective communication that results in resolved disputes. Made significant impacts by streamlining claims processing procedures, enhancing customer satisfaction through timely resolutions.
Overview
13
13
years of professional experience
Work History
Return-to-Work Specialist
Sedgwick Claims Management
Colorado Springs, CO
05.2024 - Current
- Facilitated claimant return-to-work processes by negotiating with clients and providers under disability guidelines.
- Assessed physical tolerances and vocational skills required for various employment roles as needed.
- Collaborated with case management to evaluate client competence and gather employment-related data.
- Ensured compliance with medical, legal, and accreditation standards during job modifications.
- Defined objective work restrictions based on medical documentation for each claim.
- Coordinated regular follow-ups with clients after placement to track rehabilitation progress.
- Developed relationships with employers to introduce programs and ascertain job requirements.
Documented findings and rehabilitation plans through detailed reports and communication logs.
Claims Examiner
The Guardian Life Company
Colorado Springs, Colorado
01.2019 - 05.2024
- Processed technically complex workers' compensation claims by investigating details and determining exposure.
- Developed and executed action plans for timely claim resolution.
- Negotiated settlements within assigned authority limits to mitigate losses.
- Calculated and assigned reserves, ensuring adequacy throughout claims' duration.
- Executed timely claim payments while adhering to authority guidelines.
- Prepared necessary state filings, complying with regulatory requirements.
- Managed litigation processes for efficient claims resolution.
- Utilized strategic vendor partnerships for effective cost reduction in claims.
Claims Asssociate
Concentrix
Cincinnati , OH
01.2016 - 01.2019
- Investigated and evaluated medical-only claims, managing up to 150 indemnity claims under supervision.
- Established reserves and provided recommendations within authorized limits under supervision.
- Set up designated claim files, following all setup instructions as requested.
- Coordinated independent medical exams as necessary under supervision.
- Requested and monitored medical treatment for claims in line with corporate standards.
- Reviewed and approved medical, legal, damage estimates, and invoices related to claims.
- Negotiated disputed bills for resolution under direct supervision.
- Maintained effective communication with clients and stakeholders throughout claim processes.
Claims Speicalist
Fountain Life Insurance
Naples, FL
03.2012 - 01.2016
- Facilitated timely payment of claims by collaborating with healthcare providers and insurance carriers to resolve discrepancies.
- Achieved 20% faster processing times through effective use of Fountain Life’s proprietary software.
- Regularly audited processed claims to uphold quality control and meet industry standards.
- Reduced claim denials by providing actionable feedback on common issues to medical billing department.
- Managed over 600 active claims while consistently meeting deadlines and ensuring customer satisfaction.
- Performed electronic queries for vehicle registration, warrant information, and sex offender registration status as required.
- Executed queries on employee parking lease database to assist with operational inquiries.
Education
Bachelor of Science - Health Administration
University of Pittsburgh
Pittsburgh, PASkills
- Claim processing
- Time management
- Problem solving
- Regulatory compliance
- Conflict resolution
- Negotiation skills
- Exceptional attention to detail
- Compliance protocols
References
References available upon request.
Timeline
Return-to-Work Specialist
Sedgwick Claims Management
05.2024 - Current
Claims Examiner
The Guardian Life Company
01.2019 - 05.2024
Claims Asssociate
Concentrix
01.2016 - 01.2019
Claims Speicalist
Fountain Life Insurance
03.2012 - 01.2016
Bachelor of Science - Health Administration
University of Pittsburgh
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