Claims Adjuster

Published on May 2016 | Categories: Documents | Downloads: 47 | Comments: 0 | Views: 447
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Claims Adjuster with 15 years experience looking for a Direct Contributor position.



STEPHEN E. LEARD, AIC 4314 Florio Drive Perry Hall, MD 21128 (410) 256-6021 (home) (410) 207-1444 (cell) [email protected] _PROFESSIONAL EXPERIENCE:_ XCHANGING, TOWSON, MD (2010-2011) SENIOR CLAIMS ADJUSTER * Conduct investigation and evaluate documentation to analyze coverage, compensability and damages of claims in Maryland and the District of Columbia * Establish and monitor reserve accuracy for probable ultimate exposure * Develop and manage workers compensation action plans for resolution and settlement * Work with nurse case managers and clients in developing and executing return-to-work strategies * Ensure timely denial or payment of benefits due in accordance with jurisdictional requirements * Properly document all claim coding and ensure all jurisdictional forms are filed * Maintain professional client relationships by communicating claim action with claimant and with client * Select and manage vendors to achieve appropriate balance between expense and outcome CORVEL, WHITE MARSH, MD (2009-2010) SENIOR CLAIMS EXAMINER * Conduct investigations and determine compensability and exposure for Maryland jurisdiction *

Prepare litigation referrals and plans for defense * Develop and manage claims through well developed action plans * Determine or deny any benefits due and make timely claim payments in accordance with jurisdictional requirements * Calculate and assign timely and appropriate reserves * Manage complex claims, including those involving Medicare Set Asides and Structured Settlements * Evaluate claim for potential fraud CHARTIS INSURANCE, (FORMERLY AMERICAN INTERNATIONAL GROUP): HUNT VALLEY, MD (2006-2009) WORKERaS COMPENSATION CLAIM REPRESENTATIVE * Investigate workeras compensation claims by gathering information to determine compensability and exposure in the states of Maryland, Delaware and the District of Columbia * Determine benefits due and make timely claim payments * Establish timely and appropriate reserves for probable ultimate cost and monitor for the life of the claim * Manage complex claims, including those involving Medicare Set Asides and Structured Settlements * Develop and manage claims through well developed action plans * Communicate claim activity and claim status to the insured, including quarterly claims reviews on national accounts * Adhered to and followed best claim practices on all claims achieving an overall quality score of 90% TRAVELERS, HUNT VALLEY, MD (2003-2006) Workeras Compensation Claim Case Manager * Perform telephonic case management of workeras compensation claims, including contacting the injured worker, employer and medical provider within 24 hours of assignment, focusing on Maryland and

Delaware * Manage files with an emphasis on best practices * Evaluate and investigate claims using sound claim handling techniques in accordance with company claim philosophy and standards, negotiate within settlement authority * Apply understanding of policy coverage, including those arising out employment and course of employment issues * Work with medical case managers to expedite return to work * Establish appropriate reserves to reflect ultimate exposure of the claim * Prepare files for hearing, develop defense of issues and decisions on appeals THE GALWAY COMPANY, BALTIMORE, MD (1999-2003) OWNER/MANAGER * Designed and implemented overall marketing presence of an on-line publishing and retail book store, including search engine submission and e-mail marketing * Created, designed and managed direct marketing campaigns to increase sales * Compiled, managed and created on-line content for company web site INTEGRATED HEALTH SERVICES, OWINGS MILLS, MD (1996-1998) REGIONAL RISK COORDINATOR * Responsible for daily risk management and safety operations for healthcare facilities * Developed transitional duty program to reduce the severity and frequency of workeras compensation claims * Implemented loss control and claims management strategies which resulted in reduced frequency and severity of workeras compensation claims *

Participated in quarterly file reviews of workeras compensation claims * Responsible for approval of settlement of all workers compensation claims over $10,000. MARYLAND INSURANCE GROUP, TIMONIUM, MD (1993-1996) LICENSED INSURANCE REPRESENTATIVE * Handled customer inquiries relating to coverage, underwriting and billing * Took first report of loss notice for auto and property claims * Settled auto and property claims under $1,500 * Responsible for annual customer review of auto and homeowners policies, recommending additional coverage or upgrading of coverage _PROFESSIONAL EDUCATION:_ Associate in Claims _LICENSURE_ Delaware Causality, West Virginia Adjuster _EDUCATION _ Syracuse University, Bachelor of Arts

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