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Click here or scroll down to respond to this candidateCandidate's Name , CPCUStreet Address
Email: EMAIL AVAILABLE phone: PHONE NUMBER AVAILABLESummaryWorkers Compensation ProfessionalDedicated insurance professional with 12+ years of experience investigating and processing workers compensation claims for the states of Pennsylvania and New Jersey. Excels in investigating, determining compensability, verifying coverage and processing indemnity payments and medical bills. Effectively manages multiple, high-priority projects, and takes pride in providing exemplary customer service.Key SkillsClaims Handling and InvestigationsRisk Assessment and MitigationRecognition of potential subrogationClaims Reports and DocumentationPolicy InterpretationConfidential Records ManagementExperienceTRISTAR RISK MANAGEMENT Philadelphia, PennsylvaniaSenior Claims Examiner 06/19 PresentEffectively manages a caseload of 125 to 150 workers compensation files, including very complex claims; Initiates and conducts investigation in a timely manner; Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines; Manages medical treatment and medical billing, authorizing as appropriate; Refers cases to outside defense counsel. Directs and manages as appropriateCompServices, Inc. Philadelphia, PennsylvaniaSupervisor, 04/16 to 08/18Manage day to day activities workers compensation claims unit; review initial injury reports for assignment; maintain open dialogue with adjusters regarding compensability concerns; review adjuster files for compliance with state laws and CSI objectives; ensure files are reserved properly to reflect their exposure; ensure files are prepared for claim reviews and settlement conferences; ensure good customer service for our clients as well as our internal and external customers.Senior Claims Adjuster, 09/07 to 04/16Investigated, determined compensability, and processed claims under the correct city disability program. Prepared claims for review and settlement negotiations.Documented and reserved claims for their ultimate exposure.AIG Claims Services Essington, PaClaims Adjuster, 10/94 - to 09/07Investigated workers compensation claims for compensability in the states of New Jersey and Pennsylvania. Verified appropriate coverage. Approved medical treatment and services. Authorized payment of lost time wages. Recognized potential 3rd party claims and referred to the subrogation unit for pursuit of our liens. Provided direction to the medical case managers and assign attorneys for litigated matters.EducationActivitiesBachelor of Science in Business 5/81 Widener University -- Chester, PaAssociate of Arts in Leadership 5/07 Harcum College, -- Bryn Mawr, PaBachelor of Arts in Organizational Leadership Eastern University, -- St. Davids, PaChartered Property Casualty Underwriter December 2017Co-Founder of Chester Township Cougars youth football and cheerleading program. Former scholastic Coordinator Del-Val League Youth Association. Founder/Manager of ICYAA of Chester travelling baseball team. Coordinator of MLK day of service activities for Providence Baptist Church. |
