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State Fund Compensation Insurance - Senior Workers Compensation Claims Examiner Resume Example

Grayson Parker
XXXX XXXX XXXXXX X XX, Riverside, CA 92507
Ph: XXXXXXXXXX
XXXXXXXXXXXXXXXXXX
Professional Summary

Seasoned Claims Examiner with more than 13 years of experience in fast-paced Worker's Compensation Insurance. Excellent Analytical and Time Management skills. Track record of achieving exceptional results in claim finalization and claim closures.

Responsible Sr. Claims Examiner proficient in complex claims adjusting and finalization. Passionate and motivated, with a drive for excellence. 13 years in worker's compensation insurance industry.

Skills
  • Customer and Personal Service
  • Critical Thinking
  • Negotiation
  • Judgment and Decision Making
  • Complex Problem Solving
  • Time Management
Experience
Senior Workers Compensation Claims Examiner Oct 2015Present State Fund Compensation Insurance Riverside, Ca
  • Adjust reserves to ensure that reserve activities are consistent with corporate policies.
  • Resolve complex, multiple claims, using high service oriented file handling.
  • Verify and analyze data to ensure that claims are properly documented and that settlements are made according to company practices and procedures.
  • Enter claim payments, reserves and ensure timely benefit delivery on computer system, inputting concise yet sufficient file documentation.
  • Confer with legal counsel on litigated claims to ensure complex matters are handled within the confines of the labor code.
  • Telephonic contacts with, doctors, medical specialists, or employers to get additional information.
  • Maintain accurate claim files with emphasis on bring claim to resolution. 
  • Provide accurate and timely benefit delivery on disability claims.
Senior Non-Commissioned Officer / Unit Career Advisor Sep 1986Present United States Air Force Reserve Riverside, Ca
  • Conduct follow-up interviews with members to determine if their needs have been met.
  • Prepare reports on member retention as required by Air Force Regulations.
  • Attend meetings and training workshops to further enhance skills.
  • Plan, direct, and participate in retention and re-enlistment activities.
  • Establish and enforce Air Force policies and rules governing member's retention.
  • Organize, plan and maintain retention program for over 400 plus members in the unit. 
  • Maintain an efficiency rate of 90% retention within the unit.
Workers Compensation Claims Examiner May 2008Sep 2015 State Fund Compensation Insurance Riverside , Ca
  • Adjust reserves to ensure that reserve activities are consistent with corporate policies.
  • Resolve complex, multiple claims, using high service oriented file handling.
  • Verify and analyze data used in settling claims to ensure that claims are properly documented and that settlements are made according to company practices and procedures.
  • Enter claim payments, reserves and ensure timely benefit delivery on computer system, inputting concise yet sufficient file documentation.
  • Confer with legal counsel on litigated claims to ensure complex matters are handled within the confines of the labor code.
  • Telephonic contacts with, doctors, medical specialists, or employers to get additional information.
  • Maintain accurate claim files with emphasis on bring claim to resolution.
  • Provide accurate and timely benefit delivery on disability claims. 
Worker's Compensation Insurance Technician Feb 2003Apr 2008 State Fund Compensation Insurance Riverside, Ca
  • Examine claims forms and medical report to determine liability coverage.
  • Review police reports, medical treatment records, medical bills, or investigation report to determine the extent of liability.
  • Refer questionable claims to investigator or claims adjuster for investigation or settlement.
  • Establish, monitor and maintain disability claims for a period of Six months.
  • Provide accurate and timely benefit delivery on disability claims.

Education
Associate of Science : General Aerospace Technology Oct 2013 Community College of the Air Force Montgomery, AL
Bachelor of Arts : Business Administration Jun 2002 California State University at San Bernardino San Bernardino, CA
Associate of Arts : General Education Jun 1997 San Bernardino Valley College San Bernardino, CA
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Resume Details

This is a real resume for a Senior Workers Compensation Claims Examiner in Riverside, California with experience working for such companies as State Fund Compensation Insurance, United States Air Force Reserve. This is one of the hundreds of Senior Workers Compensation Claims Examiner resumes available on our site for free. Use these resumes as templates to get help creating the best Senior Workers Compensation Claims Examiner resume.

Previous Companies:

  • State Fund Compensation Insurance
  • United States Air Force Reserve

Previous Job Positions:

  • Senior Workers Compensation Claims Examiner
  • Senior Non Commissioned Officer
  • Unit Career Advisor
  • Workers Compensation Claims Examiner
  • Workers Compensation Insurance Technician

Schools:

  • Community College of the Air Force
  • California State University at San Bernardino
  • San Bernardino Valley College

Level of Education:

  • Associate of Science
  • Bachelor of Arts
  • Associate of Arts

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