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Danitza
Claims Examiner with 10+ years of insurance industry experience
Contacto
Competencias
Experience in handling complex claims, settlements, and negotiations across multiple insurance providers.
Providing excellent service, managing referrals, and maintaining positive interactions with clients and internal teams.
Knowledge of WCAB forms, regulatory meetings, and claims reporting standards.
Managed multidisciplinary teams and coordinated staff scheduling and productivity incentives.
Experience working with nurse case managers, attorneys, and handling litigated medical claims.
Educación
Idiomas
Resumen
Senior claims examiner with extensive experience in complex claim handling, settlements, and customer service within the insurance industry. Skilled in cross-functional coordination, regulatory compliance, and staff management.
Logros Clave
- Handled over 200 complex and lost time claims with a closure ratio of 99%
- Managed an average caseload of 130+ claims across multiple insurers and accounts
- Established expertise in claims adjustments, negotiations, and cross-functional coordination
Experiencia
Sr. Claims Examiner
Handling 200 lost time and complex claims., Average intake and set up of 15 new claims per month., Closure ratio of 99%., Excellent customer service and teamwork., Referrals on a timely manner and monitor payment schedules.
Sr. Claims Professional
Handle an average of 130+ claims., Claims with lost time only., Experienced with broker and client presentations for large settlement authority request., Work in hand with nurse case managers and attorney’s to bring claims to resolution.
Sr. Claims Examiner
Make claims assignments: investigations, MSA referrals, timely referrals to nurse case management, etc., EAMS forms submissions to the WCAB., Status reports to home office and brokers on a quarterly basis., Good settlement negotiations and outcomes (awards, stipulations, compromise and release)., Able to represent Company at all necessary meetings with: client, vendor and regulatory agencies., Provide overall claims control: cost, referrals, 3 point monitoring: employee, employer, medical and closures.
Sr. Claims Examiner
Assigned exclusively to SDT/MTA account., Adjusted medical and litigated claims, with an average caseload of 130 claims., Reserving and settlement authority of up to 100,000 dollars., Excellent customer service provided to employer.
Claims Examiner
Assigned exclusively to the Tenet account., Adjusted litigated and lost time claims., Yearly claim review with client and re-insurance company., Quarterly reports and timely updates., Reserving and settlement authority reports required by client.
Pediatrics Clinic Manager
Managed a rotating staff of: 10 doctors, 5 Nurse practitioners and scheduling calendar for the satellite clinics., Direct reporting to the President., Responsible for productivity bonus incentives for the pediatric staff of 10 (to include cashiers, medical assistants, case managers, Nurse’s clinic, Healthy Families staff, volunteers and receptionists).