Responsible for the investigation, evaluation, disposition and settlement of Workers’ Compensation claims for FCBI Self Insurers Fund, including complex and high exposure claims, with minimal supervision. This includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Requires independent decision making and a high level of discretion and judgment in claim handling functions on behalf of client for claims service business operations, ensuring excellent customer relationships and quality customer service.

Administered Workers’ Comp claims pursuant to company and State regulations and ensured claims were managed and settled in a timely and effective manner, including investigation, determination of compensability and the setting of proper reserves. My clients business operated from roofing, contracting, electrical, landscaping, and refrigeration.  Handled a total of 100+ lost time/medical only and catastrophic claims with exposure ranging from 25k-500k. Strong organizational skills; effectively utilize diary system and document all activities. Communicated effectively with policyholders, injured workers, attorneys and others in a professional and timely manner.  Successfully negotiated settlements, aimed for low claim payouts/closed files, and handled EDI effectively. Responsible for approving settlement authority requested, input or decrease reserves as necessary

Responsible for the support of Sihle Agents enlisted in the Specialized Client program. Maintain working relationships with workers compensation insurance providers and insurers.  Gather comprehensive data to create reports, charts of trends in injuries. Reviews, monitors and tracks open losses and provide monthly reports to client. Review insured’s payrolls audits and loss runs to verify accuracy of NCCI rating. Complete future experience mod projection prior to renewal.

Administered Workers’ Comp claims pursuant to company and State regulations and ensured claims were managed and settled in a timely and effective manner, including investigation, determination of compensability and the setting of proper reserves. My clients business operated from roofing, contracting, electrical, landscaping, and refrigeration.  Handled a total of 100+ lost time/medical only and catastrophic claims with exposure ranging from 25k-500k. Strong organizational skills; effectively utilize diary system and document all activities. Communicated effectively with policyholders, injured workers, attorneys and others in a professional and timely manner.  Successfully negotiated settlements, aimed for low claim payouts/closed files, and handled EDI effectively. Responsible for approving settlement authority requested, input or decrease reserves as necessary.

Workers' Compensation Medical Only Examiner Sharing a Medical Only desk with another medical only adjuster with over 400+ claims. Processing bills via e-bill and 100% in house.

Assisting the claimant to seek medical treatment along with drug test. Phone communication with claimants, clients, nurse case managers, insurance carriers, attorneys, doctor's offices. Preparing wage statements and handling of litigated claims. Attending mediations as needed. Re-employment services to injured workers that are on light duty. Produced loss runs as requested. Assigned surveillance and background checks on suspicious claims.