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YYYYYY X. YYYYYY
3760
Midvale Ave., #0000 xxxxxx xxxx , xxxx , xxxxx 00000
xxx-xxx-xxxx
abc@xyz.com
Summary of Qualifications
Claims Adjuster with a consistent proven track record of exceeding performance objectives.
Experience communicating effectively with clients, colleagues and claimants to resolve claims.
Sound judgment and a work history of proactively identifying and resolving problems in real time.
Solid time management, attention to detail and organizational skills, including prioritizing tasks.
Proficient with Microsoft Word, Excel and PowerPoint.
Work Experience
Sedgwick Claims Management Services Nov. 2014-Present
Claims Representative (Oct. 2015-Present)
Handle more than 100 Workers compensation claims, communicating effectively with client and claimant.
Attempt to resolve claims and approves claim payments in order spearhead a return-to-work.
Approve and process claims, including determining benefits due and manage an action plan according to the claim or client contract.
Process complex lifetime medical and/or defined period medical claims, which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
Determine compensability and benefits due on long-term indemnity claims.
Oversee subrogation of claims and negotiate favorable settlements.
Monitor reserve accuracy and file necessary documents with a state agency.
Claims Associate (Nov. 2014-Oct. 2015)
Provided valuable, hands-on support to five different claims examiners.
Scheduled medical appointments and checked the claimants current medical status.
Filed and served documents, which included reviewing or preparing letters.
Processed indemnity payments within iVOS, a claims administration software program.
Submitted invoices for payment on behalf of a variety of vendors.
Mailed documents such as subpoenas, independent medical reviews, MSA reports and legal referrals.
Previously:
Claims Account Executive, Trainee, Octagon Risk Services 2005-2006
Branch Sales Manager, AppleOne 2004-2005
Business Development Manager, POS Products, NSA Distribution 2001-2003
Senior Product Manager, Marketing, Enterprise Software Division, Ingram Micro 1996-2001
Product Marketing Manager, Merisel Open Computer Alliance, Merisel 1991-1996
Education and Training
Bachelor of Science (BS), Business Management, University
of Phoenix
Associate of Arts (AA), Communications, El Camino College
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