Description
Summary Result oriented insurance professional with experience in processing, monitoring and adjusting claims. Particular expertise in workers compensation within a multi-state jurisdiction. A keen problem solver who is organized and detail oriented. Recognized for ability to earn trust, respect and build relationships with clients, identify false and non-compliant injuries, and assess and quickly set priorities. Consolidated Benefits Resources, Edmond, OK Claims Administrative Adjuster 2014 - 2015 * Handling medical only, lost time, and litigated claims for Oklahoma. * Medical Only claims: Setting reserves 3 point contacts, investigation of claims to determine compensability, obtaining all medical reports and scheduling referrals to specialist, payment of medical bills and complete closing summary. * Lost time claims: Addressing payout of benefits, (TTD or TPD) review reserves, approving of surgeries, DME, PT, 30 day client/claimant contact, address settlement if appropriate and payout of PPI. If claim is settled. * Litigated claims: Form 3transmittal of the file to defense attorney, address Form A, Form 9, CWMP, dispute resolutions, orders from the court of existing claims and OK Commission as of 2/1/14, address DHS liens, obtain settlement authority for Mediation of claims, address PTD reserves, review continuation of med maintenance and work with attorney to try and resolve the closure of med maintenance if applicable. Authorization of all medical treatment, monthly file reviews, on-site meetings with client risk/HR department and timely closure of claims. * Assigned all Nurse Case Managers to claims that warranted special handling. Reports of all appointments were given immediately back to adjuster to compile a workable plan for the injured worker/ employer. * Management of claims through daily diary system
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