Workers Compensation Claims Adjuster Resume
Objective : Highly qualified Administrative Professional with experience performing a variety of administrative duties with exceptional organizational skills as well as the ability to multitask.
Skills : Analytical Skills, Communication Skills.
Description :
- Investigated on the job accidents by interviewing the claimant, store personnel, looking at the video when available.
- Influenced and coordinated with the stores and the claimant for return to work of the employee even if in a modified duty capacity.
- Determined the most cost-effective resolution of each claim as responsible for all payments for medical, compensation, legal.
- Solved and effective communication in order to negotiate and reach a settlement on claims that require that type of resolution.
- Prepared detailed monthly claims report to be discussed in monthly claims meetings.
- Monitored claim for reserve accuracy and file the necessary legal documentation with each State agency in order to be compliant.
- Responsible for coordinated all care for the claimant by approving and authorizing treatment, surgery, medications, and appointments.
Experience
2-5 Years
Level
Junior
Education
Diploma
Workers Compensation Claims Adjuster II Resume
Headline : Learned new concepts quickly, working well under pressure, and communicating ideas clearly and effectively. Applied System, Multi-tasking, Work well with little supervision.
Skills : Medical Terminology, Problem Solving Skills.
Description :
- Analyzed and processing workers' compensation claims by investigating and gathering information to determine the exposure of the claim.
- Assigned timely reserves for the life of the claim. Calculated and pay benefits due; approved all claim payments.
- Handled litigated claims; communicated with the appropriate parties involved and insured timely and cost-effective claims resolution.
- Handled worker's compensation caseloads from inception to final settlement including communicating with policyholders.
- Analyzed, and evaluated claims in a timely manner Ensure legal compliance by following guidelines and account contracts.
- Resolved claims within evaluation Calculate and assign appropriate expenses to claims while monitoring adequacy.
- Trained and acted as the main point of contact for site employees who need help or have questions on new software.
Experience
5-7 Years
Level
Executive
Education
Diploma
Workers Compensation Claims Adjuster I Resume
Objective : Hard working, reliable, dedicated team player, looking for a new opportunity and a challenge to build on the public industry.
Skills : Computer Skills, Typing, Filing, Human Resources.
Description :
- Answered heavy phone lines, set up claims for work accidents.
- Verified incident details and injured body parts, set up medical treatment, billing information.
- Created computer files, monitor treatment until final release. Heavy Client Contact.Set up TTD payment if needed.
- Handled all aspects of claims from origination to resolution including investigating and evaluating client claims for benefits.
- Communicated with defense attorneys to settle litigated claims.
- Consulted with store managers, supervisors, and attorneys in the evaluation of claims Analyze case facts and monitor activities.
- Reviewed written, audio, photographic, and video evidence on claims Handled legal issues with or without the use of a defense attorney as necessary.
Experience
2-5 Years
Level
Junior
Education
Insurance
Workers Compensation Claims Adjuster III Resume
Summary : Accustomed to handling sensitive and confidential records. Demonstrated history of producing accurate, timely billing methods.
Skills : Critical Thinking, Management.
Description :
- Managed Litigated and Non-Litigated Claims Acted as a Liaison among injured workers, employers, and attorneys.
- Prepared file documentations and reports Oversaw prompt delivery of benefits; Calculated, reviewed and approved wage payments.
- Reviewed Vocational Rehabilitation Plans; Found moderate or alternate job duties for injured workers Reviewed files from inception to closure.
- Processed worker's compensation claims in conjunction with the insurance company that was paying for the claim.
- Physical therapy clinics to advise that patients had been approved for physical therapy.
- Authorized medical treatment and referrals.
- Communicated between claimants, employers and medical providers.
- Filed claims, select documents, stamp files/papers Accomplishments Working with the department of human resources.
Experience
10+ Years
Level
Senior
Education
Indiana Only
Jr. Workers Compensation Claims Adjuster Resume
Objective : Experience in the insurance business, which includes claim handling experience. This experience includes handling caseloads involving all aspects of claim handling.
Skills : Interpersonal Skills, Critical Thinking, Team Leadership.
Description :
- Successfully handled a high volume of Workers' Compensation claims in a fast pace environment.
- Completed initial investigations and contacts with clients in a timely fashion, to obtain accurate claim details, and make compensability decisions.
- Set monetary reserves, for all possible payments and exposure on each claim.
- Maintained positive rapport with internal and external customers, to promote loyalty and establish credibility.
- Managed and met claim deadlines to obtain a high claim closure rate.
- Set challenged work goals for success in a self-driven, independent environment.
- Provided superior customer service to all clients and contacts to ensure confidence and satisfaction in the services of our company.
- Negotiated lien payments and treatment options with medical providers and lien claimants.
Experience
2-5 Years
Level
Junior
Education
B.S
Sr. Workers Compensation Claims Adjuster Resume
Summary : Basically, a claims adjuster investigates workers' compensation claims to determine whether the claimant can legally receive compensation.
Skills : Problem Resolving Skills, Technical Skills.
Description :
- Assisted during open enrollment periods ensuring the employees and their dependents were enrolled as requested.
- Managed one client's medical and child care flexible spending account from enrolling the participants.
- Justified payroll contributions through reviewing and processing bills for payment.
- Processed voids and refund checks applying them to the proper claim and preparing the checks for deposit to the respective client's account.
- Processed dental and medical bills for payment.
- Set up workers' compensation claims, filed appropriate state forms, reviewed bills for compensability.
- Prepared reports for clients and re-insurance carriers.
Experience
10+ Years
Level
Senior
Education
Diploma
Workers Compensation Claims Adjuster/Co-ordinator Resume
Summary : Goal is to obtain a position with an employer that recognizes positive attitude and accurate work. Working as an integral part of a team as well as showing individuality.
Skills : Critical Thinking, Management.
Description :
- Reviewed and processed a caseload of workers' compensation claims.
- Direct cared for injured workers with the help of Nurse Case Managers.
- Arranged transportation to medical appointments if the unreliable vehicle or unable to drive due to injury.
- Paid mileage for use of personal vehicles if driving over 15 miles to appointments.
- Investigated by recorded interview of the employee, employer and witnesses to determine if the claim is compensable.
- Verified coverage per individual policy and maintain adequate money reserves to pay disability wages while off work.
- Requested surveillance on injured workers if fraud was suspected.
- Turned claims over the State Insurance Fraud Unit.
Experience
10+ Years
Level
Senior
Education
Technology
Asst. Workers Compensation Claims Adjuster Resume
Objective : Handled medical insurance calls explaining benefits and adjusting claims that had been coded improperly to the correct codes so they would pay properly.
Skills : Analytical Skills, Management.
Description :
- Ensured that medical bills were paid and that the injured workers returned back to work in a timely manner.
- Contacted with the employer, employee and medical facilities throughout the life of the claim serving as a bridge of communication between all parties.
- Responsible for knowing the claim laws for each of those states.
- Trained in all different claims systems that the company used for workers comp.
- Worked with MS Word / Works, Excel and Outlook.
- Licensed has expired but willing to get it renewed at any time.
- Evaluated and investigated claims for potential fraud.
Experience
2-5 Years
Level
Junior
Education
General
Lead Workers Compensation Claims Adjuster Resume
Headline : Friendly, loyal and clearly dedicated individual who has an ambition to succeed in any given environment. Learn and always up to a challenge whatever the situation.
Skills : Technical Skills, Organization Skills.
Description :
- Investigated and analyzed claims to determine liability and compensability of claims for various state jurisdictions.
- Prepared litigated files for hearings and negotiating settlements with the claimant's counsel in permanency cases.
- Determined the need to create and assemble case files.
- Contacted injured workers to ensure the injured worker was receiving proper care.
- Prepared correspondence and responded to inquiries on employees for the company in relation to injury.
- Processed bi-weekly indemnity payments for lost-time claims.
- Reviewed and processed medical bills for payment.
Experience
5-7 Years
Level
Executive
Education
Criminal Justice
Associate Workers Compensation Claims Adjuster Resume
Headline : Claims management and customer service specialist; dedicated to internal and external customer service.
Skills : Analytical Skills, Management.
Description :
- Managed over large deductible and self-insured claims files.
- Oversaw claims for the region and National Accounts.
- Investigated claims to determine the extent of coverage responsibilities.
- Conducted interviews, corresponded with claimants and witnesses.
- Attended mediations, responded timely to all Petitions for Benefits filed.
- Authorized all medical care and directed attorneys in all phases of litigation.
- Covered for two medical-only adjusters who are on simultaneous disability.
Experience
5-7 Years
Level
Executive
Education
Diploma
Workers Compensation Claims Adjuster Resume
Summary : Recognized strengths in proactively managing customer service issues, account maintenance, problem-solving and trouble-shooting.
Skills : Risk Management, Analytical Skills.
Description :
- Evaluated claim potential/expenses and set proper reserves.
- Documented files with necessary reports and notes.
- Monitored disability status with regards to return to work date/level of abilities and any potential long term/permanent disability.
- Managed medical and bills in a timely manner.
- Required knowledge of medical terminology and labor laws.
- Responsible for investigating and managing newly reported and existing portfolios of open workers.
- Provided quality secretarial service while working with clients and investigators.
Experience
7-10 Years
Level
Management
Education
Medical Terminology