SUMMARY:

A highly qualified and motivated individual with versatile 32 years Workers’ Compensation, Casualty, General Liability, Employers Legal Liability and Property claims handling expertise, as well as billing, collections, administration, and customer service for healthcare providers. Moving to Kingston OK in the immediate future.

Congenial working relationship with others, well liked, fair, honest, hard-working and exceptionally organized. Can handle a variety of tasks, directs others, and follows directions, rules and regulations.

EXPERIENCE:

Confidential Dallas TX 5-08 to present
Senior Claims Adjuster handling Commercial General Liability, Auto Liability for various insurance companies and their program accounts. Investigate and determine liability and appropriate claims payments, negotiate claim settlements, handle litigation and defense coordination. Prepare arbitration submissions and attend Mediations.

Confidential Irving, TX. 11/05 to 5/08
Claims Examiner III handling General Liability, Employers Liability, Physical Damage and Property Damage on behalf of Texas Association of Public Schools Property & Casualty Fund. Review claims for applicable coverage, issue coverage determination letters, process and pay claims, review all outside appraisal reports, work with attorneys for defense of claims as necessary and coordinate with excess carriers. Handle claim through to conclusion.

Confidential Dallas, TX 1/05 to 9/05

Review Workers’ Compensation billing and claims for various physicians in the Dallas area. Corrected billing, prepared Appeals, contacted insurance companies to review compensability, counseled physician and patients to understand their rights under Workers’ Compensation laws

Confidential Dallas, TX 3/04 to 1/05

Claims Specialist & Billing Coordinator responsible for making sure correct billing is forwarded to the insurance carriers for payment. Follow-up with insurance for correct payment of bills and handle Appeals, Reconsiderations, Medical Dispute Resolutions as necessary. Data entry of payments received and correct application of payments to each individual billing. Handling Workers’ Compensation, Personal Injury, Managed Care, OWCP, Medicare billing and general Business Office management.

Confidential Ft. Worth, TX 3/00 to 2/04

Claims Consultant for multi-state hospital’s Workers’ Compensation Insurance claims.
Off-site claims coordinator assuring correct payment of hospital bills by insurance carriers. Reviewed all itemized billing to assure compliance with regulations and guidelines. Represent hospital at Medical Dispute Resolution Hearings as necessary.

Confidential Hurst, TX 7/98 to 2/00

Claims Supervisor with duties including handling of litigation, complex claims files, supervision and training of up to three Claims Representatives, as well as, assignment and supervision of 5 outside adjusters, independent adjuster's and appraisers. Also, serve as medical evaluation specialist in reviewing complex injury claims to determine medical treatment relative to injury, and serve as ergonomic coordinator for office to insure compliance with national and company ergonomic standards. Attend mediations and trials with settlement authority as applicable.

Confidential USA Las Vegas, NV 9/97 to 6/98
Senior Claims Representative handling Workers’ Compensation claims for self-insured clients. Duties included general claims investigation, determination of compensability, indemnity and medical payments, monitored cases for reporting to excess carrier, representation of clients at Hearings and monitoring claims at the Appeal level which, were handled by an attorney. Provide self-insured clients with instruction and training for Workers’ Compensation. Participated in presentations of services for prospective clients.

Confidential Las Vegas, NV 8/96 to 9/97
Account Manager for self-insured client’s Workers’ Compensation program. Complete comprehensive handling of Workers’ Compensation claims including investigation, determination of compensability and claims handling through to conclusion. Represented self-insured clients at Hearings and worked closely with attorney handling Appeal proceedings. Attended regular claims meetings with clients to insure compliance and service.

Confidential Las Vegas, NV 8/94to 8/96
Confidential Detroit, MI 2/93 to 8/94
Claims Analyst handling Workers’ Compensation claims for self-insured clients, including all aspects of the claims through to conclusion. Regularly attended claims meetings and Hearings on behalf of clients.

ADDITIONAL EXPERIENCE:

From 1976 until 1993 was a claims adjuster for various insurance companies and adjusting agencies throughout Oklahoma and North Carolina and Detroit. An additional list of employment is available upon request.

LICENSE:

P & C License-Texas, Oklahoma, Arkansas, Louisiana, Kentucky, North Carolina , W Virginia, New Mexico
Pending Texas WC Adjuster License
Notary Public-State of Texas
Previous P & C in Texas, Oklahoma and North Carolina
Previous Nevada Workers’ Compensation License

EDUCATION:

Associate Degree
Pursued Bachelors Degree in Vocal Music