Insurance Claims/Specialist/litigation/representative

Sally Coleman

Jacksonville, Fl

(702)604-0793

 

PROFESSIONAL PROFILE

 

I am a highly competent, resourceful and multi-disciplined professional with over 30 years of experience in investigating and evaluating insurance claims in professional liability; workers compensation and subrogation.  I am recognized as an Associate in Claims filling the requirements of the Industries.  In 1999, I was a recipient of a Chairman’s Award of excellence.  Currently I am completing courses to obtain a Florida Certified Adjuster Designation in order to obtain an All-Lines adjuster license 5-20 or 6-20. 

 

I am recognized for my ability to prioritize; coordinate and direct multiple projects; ensuring accuracy and regulatory compliance.  I have proven and sustained a record of advancement and achievement. 

 

PROFESSIONAL EXPERIENCE

 

ProAssurance – 09/06 to present, Las Vegas, Nevada

Claims Specialist

 

Job description - manage pre-litigation and litigated medical malpractice claims requiring minimal guidance and supervision. 

 

Responsibilities include working with underwriters to confirm coverage issues; reserve analysis; conduct fact finding investigations including meetings with insureds and pro se plaintiffs; reviewing medical records; attending depositions; retaining appropriate experts along with a review of all discovery responses, in order to support decisions regarding liability and damages.  Confirmation of any and all medical liens, including Medicaid and preparing claims for presentation to appropriate committees as required.  Conduct settlement negotiations with plaintiffs or their counsel through direct contact; mediation; settlement conferences or arbitration.  Assist defense counsel in litigation and ensure attorneys are adherence to establish litigation management guidelines.  I have consistently established 100% compliance with established standards of performance.  Approve invoices from attorneys or outsider vendors. 

 

AIG – 3/06 to 9/06, Las Vegas, Nevada

Claims Specialist

 

Responsible for investigating workers compensation claims, managing a case load of over 120 claims at one time.  Investigations included interviews with claimants; employers and co-workers who may have witnessed the accident along with onsite investigations.  Make decisions regarding the validity of claims; ensure appropriate reserving along with authorizing payments of compensation and medical benefits. 

 

Zenith Administrators – 08/05 to 03/06, Las Vegas, Nevada

Claims Technical Review Specialist

 

Responsible for management of all subrogation files, including Medicare liens; reinsurance reporting along with reviewing and solving provider and insured’s appeals.  Assisted in health care claims billing and was responsible for provider relations.   

 

The Doctors Company (TDC) – 01/97 to 08/05, Las Vegas, Nevada

Claims Specialist II

 

Responsibilities the same as with ProAssurance.  Initial position was claims assistance and advanced to a Claims Specialist II. 

 

Prime Health/Silver State Medical Administrators – 03/95 to 01/97, Las Vegas, Nevada

Subrogation Specialist/Provider Maintenance

 

Responsibilities included handling all third party claims with successful negotiations; maintained and updated monthly reports to managers and clients and trained and audited other employees in the department.   Assisted in health care claims billing and was responsible for provider relations.   

 

Exchange Insurance Company – 10/91 to 10/94, Buffalo, New York

Workers Compensation Supervisor

 

Responsible for supervision of a seven member department including performance reviews; assigning claims; auditing claim files and interviewing potential claim adjusters while handling a case load of over 150 claims at one time.  Responsible for investigating workers compensation claims, including interviews with claimants; employers and co-workers who may have witnessed the accident along with onsite investigations.  Make decisions regarding the validity of claims; ensure appropriate reserving along with authorizing payments of compensation and medical benefits. 

 

New York Adjusters License and Licenses Insured Representative allowing me to argue workers compensation claims at hearings on behalf of the company. 

 

Adjustco Inc/SIS Services/Laverack & Haines – 10/81 to 10/91

Workers Compensation Senior Adjustor

 

Responsible for investigating workers compensation claims, including interviews with claimants; employers and co-workers who may have witnessed the accident along with onsite investigations.  Make decisions regarding the validity of claims; ensure appropriate reserving along with authorizing payments of compensation and medical benefits. 

 

Education

 

High School Diploma

The Institutes – Associate in Claims

  • ID#: 66876
  • Location: Jacksonville, FL , 32257

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