Resume Sample - Workers Compensation Claims
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Victoria Senses is a resourceful and motivated senior workers' compensation claims examiner seeking a new challenging position. She has over 20 years of experience managing complex claims and negotiating settlements. She communicates well with claimants, families, medical providers and demonstrates exceptional customer focus and organizational skills. She has expertise in areas such as critical thinking, writing, time management, problem solving, investigation and decision making.
Resume Sample - Workers Compensation Claims
- 1. VICTORIA SENSES 31144 Bergamot Avenue, Unit #39 Phone: 555.55.5555 Sylmar, CA 91342 Email: victoria2000@yahoo.com WORKERS COMPENSATION CLAIMS EXAMINER Resourceful and motivated Sr. Claims Examiner seeking a new challenging position is flexible and able to manage multiple complex tasks and coordinate time effectively. Hardworking and energetic; flexible; adapts quickly to change of environment and work schedule. Communicates well, obtaining optimal outcomes; in addition to swift critical thinking during catastrophic claims. Personable with a positive attitude; interfaces well with claimants, families, and medical providers, demonstrates exceptional customer focus and organizational skills. AREAS OF EXPERTISE  Critical Thinking Skills  Exceptional Writing Skills  Time Management  Strong Organizational Skills  Complex Problem Solving  Litigation Specialist  Sound Decision-Making  Investigative Skills  Medical/Disability Mgmt.  File Management  Negotiation Skills  Critical Thinker WORKERS COMPENSATION CLAIMS MANAGEMENT  Analyzes and processes workers’ compensation claims by investigating and gathering information to determine the exposure on the claim  Negotiates settlement of claims up to designated authority level  Processes complex or technically difficult claims  Calculates and assigns timely and appropriate reserves for claims and continues to manage reserve adequacy throughout the life of the claim  Calculates and pays benefits due; approves all claim payments, and settles claims within designated authority level  Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution  Prepares necessary state filings within statutory limits  Actively manages the litigation process; ensures timely and cost-effective claims resolution  Coordinates vendor referrals for additional investigation and litigation management  Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims  Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund improvements, and Social Security offsets  Reports claims to the carrier responding to requests for directions in a professional and timely manner
- 2. Victoria Senses Resume, Page 2 WORK HISTORY IPS/SEDGWICK CMS, SENIOR EXAMINER, CULVER CITY, CA 2014 – PRESENT PRG/GALLAGHER BASSETT, SENIOR EXAMINER, GLENDALE, CA 2014 PRG/Gallagher Bassett, Senior Examiner, Calabasas, CA 2012 – 2013 IOS/ONE BEACON INSURANCE, SENIOR EXAMINER, WESTWOOD, CA 1998 – 2000 CALIFORNIA INSURANCE GUARANTEE ASSOC., SENIOR EXAMINER, GLENDALE, CA 2005 – 2012 Insurance Overload Staffing ABI/Cannon, Sr. Examiner, Los Angeles, CA 2000 – 2005 EDUCATION & TRAINING AA Degree: & Western College Diploma Pierce College Kennedy High School, Granada Hills Diploma Self-Insured Administrator’s Certificate (SIP) IEA Workers’ Compensation Claims Professional Certificate (WCCA) Workers’ Compensation Claims Designation (WCCP) Designation Given by California Insurance Guarantee Association Various Continuing Education Courses and Certificates with Hanna & Brophy Academy, IEA Email: vdbenjamin2000@yahoo.com