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Posted: Monday, February 13, 2017 7:54 AM


I am in the insurance field but looking for better opportunities. Currently doing Workers Comp, but would love to do something dealing with litigation, field adjusting, Bodily Injury, SIU, Risk management, safety, catastrophe, or property. OPEN TO OTHER FIELDS AND WILL STAY IN WORKERS COMP FOR THE RIGHT POSITION.

Seeking a full-time position utilizing my skills, and experience with an aim toward perfecting a position leading to a rewarding career.
11/2014-current Sedgwick Insurance Richardson, TX
Claims Adjuster
• Investigates work comp non-subscriber services, compensability, liability subrogation/third party recovery, coverage, approvals/denials.
• Coordinates with defense counsel, police, on litigated claims providing records, reports, and preparing for court as needed.
• Participates and arbitrations and medications on complex cases.
• Issues indemnity benefits for injured workers exceeding state waiting periods.
• Communicates claim 3 point contact with claimant, client and appropriate medical contact, identifies all claimant injuries with ICD-10 coding
• Identifies suspicious claims. Recommends referral to SIU where appropriate and may assist the SIU in their investigation and settling of the claim.
• Leads several presentations on improving services within the company with customer service, litigation, payments, reviews, accuracy, repetitive claims, etc.
• Processes routine payments for prescriptions, medical equipment, mileage, and Medical Bills.
• Negotiates settlement of claims within designated authority, and manages all reserves using financial independent judgment.
• Authorizes variety of medical services for the injured workers (MRI, Physical Therapy, DME, Orthopedics, Dental, EKG, CT scan, surgery, etc)
8/2013-4/2014 ADAPT of Texas McKinney, TX
Case Manager
• Trained/Supervised clients in jails, groups, and individual settings, on coping with disabilities, socialization, crisis, non-compliance, daily living, money, safety, etc.
• Conducted service plans for clients including budgeting, financial planning, and safety.
• Made referrals for vocational, Chemical dependency, Housing, employment, clothing, food, and other services.
• Taught mental health coping techniques from sate approved curriculum.
• Reassessed service plans every 90 days to measure goals, and progress, and modified it based on client progress.
• Responded to crisis situations with proper authority to meet client needs.
• Attended/conducted various trainings on Curriculums, Drugs, SSI benefits, HIV/AIDS, client rights, new medications, etc.

2/2010-3/2013 Tarrant County MHMR Fort Worth, TX
Senior Caseworker
• Provided on-going 24-7 mental health services. Trained/Supervised clients in jails, group, individual, and classroom setting on coping with disabilities, socialization, daily living, employment, money, etc.
• Supervised services/intakes for the purpose of empowering clients to achieve goals set forth in the Treatment plan.
• Referred individuals to proper personnel regarding Substance Abuse, housing, employment, food, clothing and various other needs.
• Created training materials as needed, or taught them from curriculum.
• Supervised weekly doctor visits, cases, monthly budgets, check signing, medication, and crisis/conflict situations.
• Performed everyday customer service task with clients and vendors. Served as head liaison between the clients and outside agencies (DADS, TANF, DARS, legal system, Social Security, etc) regarding other services.

10/2005-12/2007 Federal Emergency Management Agency Texas/Louisiana
Disaster Adjuster
• Inspected property/casualty, auto, catastrophe, homeowner, Commercial, and Physical damages for The Hurricane Katrina Victims.
• Identified fraudulent claims, underwriting risks, within the guidelines and regulations.
• Prepared accurate estimates by utilizing estimation tools, systems, and contractor bids.
• Determined required and available resources for the recovery mission.
• Facilitated after-action reviews and disaster information with several agencies into recommendations to address areas for improvements.
• Expedited all government assistance applications with emergency notifications to various agencies (DHS, Medicaid, Medicare, SSI, Housing Authorities, GPA, etc)
• Negotiated with claimants to diffuse issues regarding losses/coverage, escalated all claims as advised by the government.

June 2005 Ouachita Baptist University Arkadelphia, AR
• Bachelor of Arts Degree in Psychology with a minor in Sociology
Office Skills
All lines claims adjuster license (multi states), Microsoft Word, access, Suite, Excel SharePoint, Visio, PowerPoint, QuickBooks, Kronos, ICD-9, ICD-10, Needles, Xactimate, CCC Pathways, Accupro.

• Location: Dallas

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