Workers Compensation Claims Adjuster Resume Sample

4.6
16 votes

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Melvina Bauch
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Work Experience


Workers Compensation Claims Adjuster Senior
05/2018 - PRESENT
Boston, MA
  • Maintain valid adjusters’ license(s) in states assigned or an ability to obtain same
  • Experience in handling workers comp claims
  • Experience in job-related functions or equivalent
  • Eligible to Work from home 5 out of every 10 days after completing 90 days of employment contingent on the supervisors’ approval
  • Reviews circumstances involving claims brought against the company, through research, investigation and interviews
  • Advises management on various contractual issues relating to insurance and claims. Manages and oversees all aspects of claims brought against Company, including intake, investigation and disposition of those claims
  • Determines necessity and manages independent adjusters and investigators. Liaisons with the legal department and participates in mediation, negation and arbitration for the company during trials
  • Makes recommendations to upper management on potential claims settlements
  • Keeps apprised of various trends and litigation in industry and recommends changes to insurance/claims programs as necessary
Workers Compensation Claims Adjuster
02/2016 - 02/2018
San Francisco, CA
  • Manages an active file load of claims and prepares monthly claims reports for management
  • Evaluates claim exposure and establishes reserves for both settlement and handling costs
  • Exercises proper discernment and decision making to analyze the claims exposure, to plan the proper course of action and to appropriately settle the claim
  • Handles claims consistent with clients' and corporate policies, procedures and standard methodologies and also in accordance with any statutory, regulatory and ethics requirements
  • Experience in job-related functions or equivalent Insurance coursework (e.g. IIA, CPCU, SCLA and AEI) is beneficial
  • Review, process and conclude Workers’ Compensation claims or those limited in exposure but occasionally complex in nature
  • Facilitates the Summary Plan Description (SPD) development process
Workers Compensation Claims Adjuster Senior
07/2010 - 09/2015
San Francisco, CA
  • Works with HR Managers throughout the enterprise to ensure the SPDs are accurate and delivered in a timely manner
  • Facilitates the annual review of SPD sections to identify any in need of redistribution to the target audience
  • Facilitates the process to determine and dispose of obsolete SPD media numbers through Media Logistics
  • Uses pre-established templates to either add or change SPD Binder Inserts and Table of Contents
  • Facilitates the development of each SPD’s master list of Recipient Selection Parameters
  • Maintains SPD historical records including: Distribution Dates, Recipient Selection Parameters, Section Effective Dates and related Section Content
  • Translates current master of SPD content for each section into PDF format (for web placement, printing, and distribution)
  • Updates website (secured access by only Facility HR/Benefit Representatives and Global HR/Benefit Representatives) with current master of SPD content for each section

Education


Johnson & Wales University (JWU Charlotte)
2005 - 2009
Master's Degree in Management

Professional Skills


  • Skills to communicate and work well with top level agency personnel in sometimes awkward situations, active listening skills, reading and comprehension
  • Excellent analyzing, evaluating, research, organization, and prioritization skills
  • Excellent judgment, written and verbal communication skills
  • Organizational skills to balance case loads
  • Customer service and time management skills
  • Skill in calculating reserves, negotiating compromises and settlements
  • Experience handling high severity claims including: wage loss, permanent total, and odd lot exposures

How to write Workers Compensation Claims Adjuster Resume

Workers Compensation Claims Adjuster role is responsible for training, compensation, litigation, insurance, health, negotiation, exceptions, media, logistics, benefits.
To write great resume for workers compensation claims adjuster job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Workers Compensation Claims Adjuster Resume

The section contact information is important in your workers compensation claims adjuster resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Workers Compensation Claims Adjuster Resume

The section work experience is an essential part of your workers compensation claims adjuster resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous workers compensation claims adjuster responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular workers compensation claims adjuster position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Workers Compensation Claims Adjuster resume experience can include:

  • Experience handling NY workers’ compensation claims
  • Independently prioritize multiple tasks and responsibilities
  • Experience in Compensation & Benefits
  • Reviewing, interpreting and applying laws, rules, procedures and court decisions
  • Analyzing insurance, medical and legal documents of moderate to high complexity to reach logical claims determinations
  • Oversees, directs, delivers and ensures delivery of initial privacy training and orientation to all appropriate employees

Education on a Workers Compensation Claims Adjuster Resume

Make sure to make education a priority on your workers compensation claims adjuster resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your workers compensation claims adjuster experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Workers Compensation Claims Adjuster Resume

When listing skills on your workers compensation claims adjuster resume, remember always to be honest about your level of ability. Include the Skills section after experience. Present the most important skills in your resume, there's a list of typical workers compensation claims adjuster skills:

  • Effectively utilize the Valley Oaks System (VOS) to manage all claims electronically
  • Skill in negotiating with plaintiff attorneys
  • Insert any particular skill or area of expertise that the hiring manager, has considered important
  • Skill in investigation techniques
  • Analytical skill necessary to make decisions and resolve complex issues inherent in handling losses
  • Obtain and maintain valid adjuster’s license as jurisdictionally required

List of Typical Skills For a Workers Compensation Claims Adjuster Resume

1

Skills For Workers Compensation Claims Adjuster, Hawaii Resume

  • Willing to execute Gallagher's Employee Agreement or Confidentiality and Non-Disclosure Agreement which requires, among other things, post-employment obligations relating to non-solicitation, confidentiality and non-disclosure
  • Gallagher offers competitive salaries and benefits, including: medical/dental/vision plans, life and accident insurance, 401(K), employee stock purchase plan, educational expense reimbursement, employee assistance program, flexible work hours, training programs, matching gift program, and more
  • Adapt to changing circumstances
  • Receive and understand complex data; investigate and evaluate facts relating to claims within authority level
  • Thorough understanding of "litigation and management" is necessary to control the large value/complex claims
  • Knowledge of insurance coverage and adjusting principles
  • Knowledge of reporting requirements for Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of 2007
2

Skills For Workers Compensation Claims Adjuster Senior Resume

  • Easily adapt to changing work processes and environment
  • In-depth knowledge and understanding of Illinois Workers’ Compensation Act, medical terminology and anatomy,
  • AZ Driver’s License Required
  • Interpret large & complex claim files
  • Manage heavy workload with high level of accuracy and production
3

Skills For Senior Workers Compensation Claims Adjuster Resume

  • Learn computer systems and applications
  • Work well within a diverse and inclusive office environment
  • Exercise discretion and judgment
  • Interpret applicable standards and make recommendation consistent with appropriate interpretations
  • Interpret laws, standards, rules and procedures
4

Skills For Workers Compensation Claims Adjuster Resume

  • Report status of investigation and research
  • Workers’ Compensation law, policies and procedures
  • Arizona workers’ compensation statutes, rules of procedure, regulations, Court of Appeals and Supreme Court decisions regarding workers’ compensation law
  • Federal and State vocational rehabilitation laws
  • Insurance and legal terminology
  • Microsoft Office Suite; Outlook, Word, Excel
5

Skills For Workers Compensation Claims Adjuster, Hawaii Resume

  • Considerable knowledge of Arizona's Workers' Compensation laws, rules and regulations, and claims management practices
  • Knowledge of early return to work programs, medical and insurance terminology, ADA and disability management
  • General knowledge of managed care environment, information systems/database for claims management
  • Considerable knowledge of subrogation techniques
  • Comprehensive knowledge of the operations of state government
6

Skills For Workers Compensation Claims Adjuster Senior Resume

  • Knowledge to understand and evaluate information from physicians (e.g., medical terminology)
  • Knowledge of subrogation procedures and investigation techniques
  • Extensive knowledge of Arizona Revised Statutes, Arizona Administrative Code, Executive Order, and judicial protocol, intergovernmental agreements, contract law, investigations, and discovery procedures associated with litigation management and claims handling, confidentiality and preservation of evidence
  • Manage 50 - 75 casualty claims on assignment
  • Acceptable caseloads vary based on the jurisdiction(s), mix and complexity of Worker’s Compensation cases as determined by Claims Supervisor
7

Skills For Senior Workers Compensation Claims Adjuster Resume

  • An Arizona Adjusters License and Industry Certification such as Workers Compensation of America (WCCA), Workers’ Compensation Claims Professional (WCCP) and Chartered Property Casualty Underwriter (CPCU)
  • Knowledge of EDI filing requirements
  • Proactively identify gaps in work processes and present solutions
  • Analyze cases, the ability to discuss cases with corporate and private physicians and attorneys, and the ability to work one-on-one with injured employees
  • Texas Insurance Adjustors license required
8

Skills For Workers Compensation Claims Adjuster Resume

  • Communicates distribution needs to the Global HR Distribution Process Owner
  • Provides developmental guidance and assist in the identification and maintenance of company privacy policies and procedures in coordination with department management and legal counsel
  • Performs periodic information privacy risk assessments and conduct related ongoing compliance monitoring activities in coordination with the organization's other compliance and operational assessment functions
  • Works with legal counsel and management to ensure the company has and maintain appropriate privacy and confidentiality consent, authorization
  • Participates in the development, implementation and ongoing compliance monitoring of all business associate agreements to ensure privacy requirements are addressed
  • Establishes with management and operations a mechanism to track access to protected health information within the purview of the company, as required by law

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