CORE COMPETENCIES Employment Law FMLA/ADA/EEO/WC WC Program/Project Management WC/HR Policies & Procedures
WC New Employee Orientation Training & Development Performance Management Organizational Development Staff Recruitment & Retention Employee Relations Benefits Administration Safety Programs Litigation Management
Lawson WebEnvision Workers Compensation Claims Management Software Microsoft Windows XP/Vista / 7 Microsoft Outlook / Word / Excel PowerPoint - Publisher Microsoft Internet Explore
Regional Worker’s Compensation Claim Manager February 2012 to August 2015Company Name － City, State
Primary accountability and results for specific functions.
List by order of importance.
The list of essential functions is not exhaustive and may be supplemented or changed as necessary.
order of importance.
Manage workers’ compensation claims from date of loss through final resolution including involvement in accident investigation, primary TPA adjuster interface, reserve review, monitoring of effective medical care, coordination of transitional modified duty, attendance at legal proceedings and involvement in resolution strategies.
Support the partnership with Operations and Safety to identify trends and opportunities for improvements in tools, training or processes and procedures.
Educate, train and provide support to Operations in the development and execution of consistent Workers Compensation claim management programs.
Evaluates Workers Compensation risk mitigation in conjunction with external and internal relationships; develops, seeks approval for, implements, monitors and modifies programs to achieve desired objectives.
Builds, maintains and manages relationships with third party administrators, legal counsel and other claim related parties including occupational groups and investigators.
Improve the quality of and ensure the effective execution of post loss claim management processes.
following agreed claim handling standards and best practices.
Proactive identification of operational claim strategies that potentially help to mitigate the cost of claims including program development, implementation, communication and training to effectively achieve defined goals.
Provide leadership to Operations for the Workers Compensation claim processes and claim resolution strategies.
Measure and monitor the overall Workers Compensation claim management performance and identify opportunities for improvement.
ADDITIONAL RESPONSIBILITIES: Lead and manage special projects as assigned by Director of Claims and Vice President of Risk.
Remain current on Workers Compensation/Safety issues.
Manage and oversee development of claims processes, procedures and vendor relationships.
Attend mediations on litigated matters.
Worker’s Compensation Manager, Legal Dept January 2002 to January 2010Company Name － City
Managed and directed the Workers’ Compensation and Risk Management Division of Human Resources and Legal Department on a daily basis.
Effectively manage Company’s workers’ compensation claims, including organizing, implementing and delegating jobs, and monitoring a front-line processing staff of four: one Administrative Assistant, one Medical Only Adjuster and two Loss Time Adjusters.
DEIRDRA DANIELS Page 2.
CHILDREN’S NATIONAL MEDICAL CENTER continued: Implemented claims processing and safety procedures for all managers and employees.
Independently determined whether claims have been properly adjudicated and drafted final decision for affirming the findings of fact and conclusions of law.
Decided whether the recommendation should be reverse or accepted of the claim.
Evaluated medical reports, employment evidence and other types of evidence submitted in support of a claim for benefits.
Developed and met specific goals, conducted weekly staff meetings, and motivated all team members for high-quality and prompt claim closure.
Provided workers’ compensation training to 4000 employees at Headquarters and 1,500 employees at fifteen (15) satellite offices on how to initiate, complete appropriate forms and forward to Worker’s Compensation Department for correct processing of employees’ incident(s).
Reviewed high volume of claims, assured adherence to contracts, negotiated contracts, and approved claims.
Also oversaw & managed unemployment claims.
Collected data daily and preparing Workers’ Compensation monthly audits to minimize risk exposure.
Administered and approved claim programs, developed and provided monthly status reports programs.
Developed claim guidelines and managed the activities of third party workers, compensation administrators.
Developed and administered procedures and processes for budgetary reporting; recorded and analyzed the claim data.
Reduced the CNMC open claims from nearly 2,000 in yr.
2002 to less than 700 in yr.
Decreased annual losses from $8 million to $3 million within a five-year period.
Monitored worker’ compensation claims and coordinated with employees, the department of Occupational Health, mangers of employees, and insurance carriers.
Prepared reports, including loss reports and OSHA reports.
Assisted operations to improve shrink performance through training management staff, Occupational Health, Human Resources and all employees of the hospital.
Enforcing policies and implementing new procedures.
As the hearing representative advised Claims Representatives in discrepancy situations in order to avoid potential and costly litigation by applying the relevant law, regulations, and program procedures to the facts of the individual claim to reach a conclusion on the disposition of the case.
As the hearing representative for CNMC and Avizent Corporation at all hearings and related meetings I prepared statements of fact, and statements of issues in controversial cases involving novel situation or establishment of new precedents and policies.
As the hearing representative attended and guided mediations, judge and jury trials, arbitrations, and jury selections.
Used my discretion to allow the claimant/representative/witnesses to present argument/testimony/material that is relevant to the claim and accepted evidence introduced during the hearing and identified the same for the record.
Strategized with county attorney’s to establish course of action for settlement and stipulation.
Reviewed RFP for new potential clients and provided recommendations to minimize risk exposure.
Created and developed CNMC company’s first-ever standardized Online Incident Report and Light- Duty Back-to-Work Program tracking systems that insulated company from legal risk and ensured consistent management accountability for employee claims and processing.
Created the first Departmental for non-injury per month Award Program.
Created the first Employee(s) Injured After-Hours Insurance Procedure Program.
Risk/Loss Prevention Manager January 1999 to January 2002Company Name － City, State
Managed and directed the Workers’ Compensation and Risk Management Division of Human Resources on a daily basis for headquarters and all regional offices in DC, MD and VA.
Owns shrink and safety results for assigned areas, as well as substantiated and documented the Loss Prevention five play strategy.
Managed and conducted the training of staff and upper management to detect, investigate and successful resolve all internal high dollar (over one million dollars) and sensitive investigation within assigned stores.
Improved Quality of Risk and reduced insurance costs 1.2 million by: creating & implementing loss prevention standards and an internal audit system; creating & training professional teams in; introducing internal reporting, measurements, and accountability; meeting regularly with insurers to inspire confidence.
Conducted assessments of Loss Prevention and operational performance that impacted shortage control and made recommendations to department heads and CEO.
Knowledgeable in the areas of safety, OSHA and environmental programs, and ensured implementation and compliance in assigned geographical areas.
DEIRDRA DANIELS Page 3.
MATTRESS DISCOUNTERS continued: Ensured the timely and accurate reporting of results and assisted in the development and implementation of corrective actions.
Recruited new hires, trained, and supervised the Loss Prevention Associates and Leads within assigned areas.
Ensured accurate and timely report writing, record keeping and retention of evidence by conducting periodic reviews.
Demonstrated courageous leadership by identifying and communicating potential ethical or safety issues.
Ensured follows-up on required inventories and audits in order to control costs and shrinkage Administered and approved claim programs, developed and provided monthly status reports of programs.
Developed claim guidelines and managed the activities of third party Workers ‘Compensation Administrators.
Developed and administered procedures and processes for budgetary reporting; recorded an analyzed claim data.
Prepared reports to include loss reports, auto liability, property claims, and OSHA reports, certificates of insurance, pre-employment testing and cross training benefits.
Directed the defense of workers' compensation, auto liability, and certain general/product liability litigate.
Bachelor of Arts (BA) : Business Administration and Computer Science, 1987SOUTHERN CALIFORNIA UNIVERSITY &mdash － City, StateBusiness Administration and Computer Science
Administrative Assistant, attorney, benefits, contracts, clients, DC, forms, Human Resources, Insurance, internal audit, Lawson, leadership, law, Legal, litigation, Loss Prevention, Director, meetings I, meetings, Excel, Microsoft Outlook, PowerPoint, Publisher, Microsoft Windows XP, Word, monitors, novel, Occupational Health, organizing, policies, processes, program development, Quality, record keeping, report writing, reporting, RFP, Risk Management, Safety, strategy, Vista
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