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Click here or scroll down to respond to this candidate1222 Skylight RdPhone: PHONE NUMBER AVAILABLEEMAIL AVAILABLECandidate's Name
ObjectiveA proactive, productive individual, demonstrating a high level of initiative in leadership, supervision, communication, with excellent time management. Strong ability to multi-task and meet deadlines. Welcomes new challenges and is interested in a position where my skills and experience will be an asset to the organization. Has worked as a Medical Assistant for 8 years before becoming a vital part of Worrkers Comp.For the past 27 years I;ve been Experienced in working for of employesr and insurance company. Full spectrum of experience includes, Senior level Field Adjuster, on-site thorough accident investigations, safety training for employees and managers, marketing, cost saving analysiss, developing safety programs and assures they are adhered to. Strong abilities of thinking outside the box and using a multitude of services during accident investigations to assure no stone is unturned and to achieve the best possible outcome.My resume comes with a wealth of knowledge. I am longing or a long term prison in my hometown where I can make a difference.EducationNew Albany High School - High School Diploma 1988Phillips College 1991- 3.7 GPA Certified Medical Assistant: 10-year career working in the medical field.Licensed Independent Multi-Line Insurance Adjuster 2001 Specializing in Workers Comp Kentucky, Indiana, Tennessee, West Virginia.Continued Education -. Ongoing training in relation to work comp law changes..Numerous years of experience in on-site accident investigations as well as subrogation and third party liability investigations.Work ExperienceAdvantage Surveillance June 2024 - CurrentTitle: Surveillance Researcher SpecialistIn-depth research in finding and pinpointing Workers Comp ClaimantsFinding fraudulent activity reducing the cost of claims, restitution and possible jail time.In-depth medical research and finding pre-existing conditions.Inplementing search engines and social media sites to ultimately build cases against fraudulent Claimants.Presents in court to prove fraud and misrepresentationFord Motor Co March 2022 July 2023Title: Senior Level Workers Comp claim adjuster/investigation Specialist- KY Work Comp Adjusters LicenseHandles all indemnity claims.Determines complexity of new claims.Works closely with plant Physicians regarding diagnosiss and need for treatment.Works closely with plant safety, leads and supervisors to discuss injury, examines job and accident area to determine causation, root cause and compensability.Directs and works with Defense Attorneys on complex legal cases to get best outcomes.Keeps track of all case types, looks for trends, and ways to prevent future injuries.Handles each claim appropriately and to assure best outcome.Works on projects and cost saving analysiss reports, as well as new ideas for cost savings.Provides safety training to supervisors and managers to assure accident investigations are prompt, thorough, when an injury does occur. Further, photograph the accident, preserving the accident scene, promptly, obtain witness names and rope off the accident scene, determine if video was on during the accident and obtain as many statements as possible.We are looking for the root cause, if a machine is involved it will need to be preserved until the investigation is completed. Occasionally we will need to bring in experts to determine if there was a malfunction with the machine or if it was human error.We will also need all training manuals and policies. That show the employee was trained and licensed to drive the lift.More importantly, if there was a policy in place, was that policy adhered to. Meaning, were policies, in place where employees could see them, were such policies enforced, documented and were there reprimands for failure to comply with policies, or demotions or increased training is needed. If the accident was caused by the driver, generally there would be a reprimand or demotion or possible termination if the root cause was driver error.There is a 15% deduction in indemnity benefits if the injured worker did not follow policy, however, if it is found that the employer was liable for the accident, the injured worker could get a 30% increase in all indemnity benefits.I did speeches all over the state of KY for over 10 years.Gallagher Bassett Services August 2021 to Feb 2021Title: Senior Work Comp Adjuster- Handling the States of Florida, South Carolina, North Carolina, Mississippi, Kentucky and Louisiana.In-depth and detailed claim investigations required on allClaims.Pursuing all details of the alleged accident, witnesses, cameras, statements from supervisors and coworkers.Investigate whether proper PPE was worn and safety policies were followed.Review of employees work history file. Obtaining a full medical history from the claimant and rule out preexisting injury to the same body parts, obtain a signed medical waiver and pursue medical records from health provider if there are red flags or indication of prior histories.All facts and details must be obtained to make a prompt and firm discission regarding compensability.Assurance that reserves are set in a timely manner and are based on information known at that time.Great American Insurance - Strategic Comp: Oct.2010 to Mar 2021Title: Licensed Senior Field Adjuster -Specializing in Complex & catastrophic Workers Comp claims.Thorough field accident investigations throughout the state of KY.Investigations to include prompt and in person accident scene investigations.Interviews with injured workers, witnesses, supervisors, and safety teams.Providing direction on preservation of accident scenes when applicable.Bringing in third party experts when machinery or other equipment is involved to assist with determining the root cause of the accident.Immediate in person communication to seriously injured claimants as well as family and loved ones.Working with and negotiating with Plaintiff attorneys to come to settlement resolution.Attendance at depositions, benefit review conferences, mediations and hearings.In person training insureds managers, supervisors and safety teams on a variety of important topics. Examples: Safety violations & laws. How to prevent safety violations. Importance of ongoing safety training and record keeping. Importance of adhering and to policies and procedures, and documented discipline for failure to follow.In depth Subrogation investigations at a level above the rest of TPAs and other insurance companies.Specializing in full resolution settlements, including MSAs, Non- submit MSAs, Annuities and third-party vendor medical settlements that allow the claim to close permanently.In serious injuries where hospitals fail to post-accident drug screen, Ive obtained subpoenas signed by ALJs that require hospitals to preserve all bodily fluid. At which time a Mobil lab will retrieve for testing at another laboratory when the hospital fails to obtain testing.Gallagher Bassett Services Oct 2003 to Oct 2010Title: Supervisor Senior Claims Adjuster.Over a period of eight years worked under three titles, ultimately securing the role of supervisor.Very strong time management skillsAggressive Claims HandlingStrong Leadership SkillsAbility to assist and mentor others..references upon Request |
