results-oriented professional with proven capacity to handle various functions necessary in advancing the internal operations of an organization. dynamic communicator and persuasive speaker, able to forge meaningful associations with clients, colleagues, and management. highly skilled in the investigation and research skills required to provide solutions to organizational needs. talent to identify the needs of clients and to encourage a risk-free, positive atmosphere to meet those needs.
claims examination / file maintenance / client relations
written & verbal communication / professional development and training
sr. claims examiner, 09/2008 c 11/2009 ~ matrix absence management, portland, or
sr. claims examiner, 05/2006 c 09/2008 ~ cambridge integrated services, portland, or
investigated, evaluated, and settled washington state workers compensation claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
paid and processed claims within designated authority level; adjusted claims or provided claims processing recommendations to ensure that activities are consistent with corporate policies.
entered claim payments and new claims on computer system, inputting concise yet sufficient file documentation.
resolved complex claims, using high service oriented medical record and file handling.
appointed attorneys for litigated claims and maintained claim files such as records of settled claims and an inventory of claims requiring detailed analysis.
possessed a thorough comprehension of title 51 of the rcws, wacs, and department of labor and industries policies.
sr. claim examiner, 07/2002 c 03/2005 ~ risk management planning group (rmpg), mineola, ny
oversaw a large caseload of 450 c 500 claims with varying degrees of complexity and some needing litigation or further legal review.
stood as tpa for the nys liquidation bureau and researched and completed due diligence on coverage issues, 3rd party claims, and handled claims with special funds.
sr. claims examiner, 06/1999 c 07/2002 ~ sedgwick cms, seattle, wa
verified and analyzed data used in settling 150 c 175 claims to ensure they are valid and that benefits are paid according to company practices and procedures.
examined and investigated claims investigated by others, further investigating questionable claims to determine whether to authorize claims for second injury/special funds.
sr. claims examiner ~ frank gates service company, seattle, wa
legal assistant ~ bogin, munns and munns, orlando, fl
claims examiner ~ fred s. james. company, altamonte springs, fl
seminole community college
nassau community college
<<first name>> <<last name>>
<<street address, suite #>>
<<city, state zip code>>
dear <<courtesy>> <<last name>>,
it is with great confidence that i offer my years of experience and strong client relations ability to your organization. as i pursue the <<position title>> within <<company name>>, i recognize that my credentials and experience would greatly assist in reaching future goals and objectives.
experience as senior claims examiner and legal assistant is the basis for my confidence that i would be a valuable asset to your organization. i consistently communicate the corporate vision to the internal members of the organization so that everyone understands their role in achieving these goals, ensuring that the action steps are taken to ensure that goals are met and developing plans to achieve those goals. thereafter, i regularly prepare recommendations for improvements in policies, controls, new methods, and other changes to improve the efficiency of operations.
during my career, i ve gained notable experience leading and training other employees. my professional background also includes a proven expertise in claims review, records management, quality control, research, document generation and review, and effectively communicating with clients and members of the team, verbally and in writing.
my aptitude for evaluating complex problems and reviewing related information to develop viable solutions would be of great use to your organization. i welcome more discussion about how my skills can help in meeting the goals and objectives of your organization. until then, should you have any additional questions feel free to contact me at your convenience.
yyyyyy x. yyyyyy
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