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Workers Compensation Claims Adjuster Resume Samples
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0-5 years of experience
Aggressively investigated workers compensation claims for over 20 clients.
- Actively managed over 180 open workers compensation claims, including directing medical treatment and distributing compensation benefits.
- Successfully conducted quarterly claims reviews with all clients to keep them abreast of their open claims and claim strategies.
- Maintained high level of confidentiality in handling clients’ medical claims, including knowledge of HIPPA.
0-5 years of experience
- Investigated claims to determine compensability; Demonstrate proper claim handling within authority.
- Authorized changes in medical providers, medical management, rehabilitative services, vocational training or other procedures or services.
- Provided temporary disability payments and monitors case for continuation of benefits; terminates payments when appropriate; Return to work
- Conducted negotiations for settlement of claims with claimants and attorneys; insure preparation and filing of necessary legal documents.
- Prepared reports on claims and loss statistics and other information as required.
6-10 years of experience
- Managed 100+ cases consisting of medical files and lost time files for the State of Nebraska; Updated and maintained files as appropriate.
- Performed claims processing which included investigation of claims, determination of compensability and setting reserves on reported claims, based on the type of injury and treatment recommendations from healthcare providers.
- Liaised with healthcare providers to request and review medical treatment notes to adhere to strict recovery timeline and payment timelines to efficiently process claims closures.
- Ensured adherence to organizational best practices and client service requirements for completion and claims closures.
0-5 years of experience
- Developed interactive Excel spreadsheet for the calculation of disability benefit payments
- Coordinate treatment for injured workers between their employers and treating physicians
- Adhere to the custom tailored guidelines of each employer regarding coverage and financial reporting
- Stay compliant with state legislature enforced through the Industrial Commission of Arizona
- Ensure appropriate care is provided to injured workers in order to facilitate timely recovery
0-5 years of experience
Customer Service for Call Center (In-bound, Out-bound)
- Preparation and mailing all Claims Letters for Liability and Worker’s Comp. (Treatment Authorization forms, Benefits packages, Co- pay’s, Employee Earnings Reports, Denial’s, Travel Reimbursements, Etc.)
- Worker’s Comp Medical Bill Indexing to assigned adjusters
- Medical billing reviews for Evaluation Of Bills
- Contact Medical Providers for Proper Billing (Ub4 or HCFA1500), Medical Records (DWC-25-Treatment status forms, medical notes) and W-9 for payment
- Open and process all Workers Comp claims as well as adding new W9 vendors
- Run ISO background search on claimants
- Report state filing (CMS Reporting)
- Coverage confirmation of policy’s
0-5 years of experience
- Manage and investigate a case load of up to 130 – 150 workers compensation claims.
- Provide outstanding service to UFG insured’s, claimants and medical partners
- Process timely payments and state filings
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[Workers Compensation Claims Adjuster]
Last edited by: Gabriela Barcenas, CPRW, Content Writer II -
Gabriela Barcenas
CPRW, Content Writer IIGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
