Regularly submit/monitor claims to ensure compliance with OSHA regulations & the Industrial Commission Office. Pulling wage data and providing it to adjusters to ensure Temporary disability payment are compliant within different jurisdiction laws Shadow adjusting and acting as a liaison between the injured worker, client and TPA for Workers Comp losses Detailed claims analysis, accident and subrogation investigation identifying red flags and potential fraud. Ensure accurate reserving practices, facilitating light duty, oversight of both medical and legal management. Ability to evaluate settlement value and coverage issues. Mitigating claim severity and driving positive claim outcomes by leading our TPA towards claim resolution. Preparing and presenting strategic claim reviews with client and/or carrier.

• Increased level of authority releasing payments up to $10,000 handling complex commercial claims by confirming coverage, liability, and vehicle ownership through TLOxp• Recognizes and identifies body parts of a vehicle and other potential property damage• Pinpointing material misrepresentation during recorded statements; such as, Garaging, Business Use, Unlisted Household Members and submitting notice to underwriting as needed• Respond to attorneys diminished value timed demands; as well as, utilizing ISO (Insurance Services Office) to complete in depth vehicle history reports on prior perils & submitting them to TPA Comsearch for final review• Coordinating inspections and maintaining communication necessary to ensure the inspections completed in a timely manner to stay in compliance with cycle goals• Draft State mandated letters as required, Reservation of rights, Acknowledgment letters, and storage& mitigation letters• Manage my daily reserve report weekly through excel to ensure no claims assigned to me were missed• Handle injury claims from minor injury to fatality, ensuring the claims addressed correctly; sending state mandated letters to maintain compliance• Review subrogation demands in Arbitration Forums; manually typing release documents & pro rata letters

• Investigating the circumstances of the claim by reviewing police reports and obtaining Quality firstcontact statements from policy holders, claimants, and witnesses to establish liability• Explain itemization of damages and coverage to the policy holder/claimant while regularly resolvingcomplex disputes between both parties regarding their rights and procedure guidelines• Review state negligence standards to make decisions consistent with claims standard and local lawsand send required/denial letters as needed• Process 33-38 claims daily to the fullest extent to close the claim or send to subrogation whilemaintaining 95% satisfaction rating monthly• Highest performing adjuster for two weeks straight by closing 9 claims a week• Coordinating Enterprise, and Hertz reservations for customers – and reviewing the estimate laborhours to ensure the rental reservations is only used as needed• Assess loss details and coverage limits before reassigning claims to Total Loss, PIP Med Pay, SIU• Review photos and run reparability reports to send assignments to Salvage vender IAA, Copart.• Set up tows with TPA Agero and negotiate storage fees with storage yards.• Evaluate estimates/supplements & issue payments, split code payments for uninsured motorist claims.

• Inbound calls from Adjusters/Insureds/Contractors and manually creating new work orders through email, and fax• Work with over fifteen carriers and property owners dispatching 51-60 residential, large loss, and commercial claims for water mitigation, mold remediation, leak detection, tree and debris removal, temporary tarps, content pack out and cleaning, smoke remediation services.• Provide unparalleled and empathetic customer service to client.• Manage pending claims in XactAnalysis, Symbility, Sightline to ensure the contractor follows the client, specifics from each carrier & upload the estimate/eagle view within the carriers SLA guidelines.• Assist with catastrophic 2021 snowstorm impacting Texas by working on call

• Administratively set up workers comp referrals in software tracking systems; documenting brief descriptions of the injury or injuries averaging 35 daily referrals telephonically, fax, & emails for dedicated account• Perform audits/clinical reviews to identify potential gaps in medical treatment to ensure all treatments are warranted and in compliance• Analyze high exposure claims while tracking the delivery of durable medical equipment• Review authorization logs & work with TPAs to obtain final authorization to schedule Functional capacity evaluations• Processing RX's from the referring MD office, discharging nurses, case managers scheduling diagnostic testing, Physical Therapy, deme equipment.• Address escalations to identify the root causes of escalations; creating coaching documents to assist colleagues on my team• Selected to participate in lean six sigma yellow belt

• Average 160 outbound calls daily to secure ground transports Sedan, Wheelchair, and Stretcher, Basic and Advanced Life Support, and Non-EMS air ambulance.• Negotiate pricing with vendors to maximize financial benefit, updated client files with relevant demographic data calculating miles from the patient to the treating facility.• Creating new relationships with clients and claimants to cultivate industrials strength customer service.• Monitor/Track trips with Lyft for medical appointments• Average an 97% monthly performance metrics, such as quality, schedule adherence, and average handle time.

• TOP Performance Sales, Month over Month, exceeding $6K sales goal.• Promote Dillard's card and services benefits to customers averaging 5 new card accounts weekly.• Proficient in opening credit card accounts, card upgrades, cash handling and reviewing accounts for reconciliation.• Proven ability to problem-solve, demonstrated patience while managing customer complaints and driving customer loyalty to deliver on brand promise.