Summary
Overview
Work History
Certification
Timeline
Generic

Antionette Vines

Lakewood

Summary

Self Insured Certification

Overview

25
25
years of professional experience
1
1
Certification

Work History

Senior Claims Consultant

CCMSI
12.2024 - Current
  • Developed comprehensive reports on claim trends, facilitating data-driven decision-making by senior management.
  • Delivered informative presentations at industry conferences or workshops to strengthen relationships with key partners while sharing expertise on current trends in claims consulting services.
  • Assisted in the development of new policies, procedures, and guidelines for claims management to ensure ongoing alignment with industry best practices and regulatory requirements.
  • Increased efficiency with the integration of technology solutions into daily work processes, automating routine tasks wherever possible.
  • Identified suspicious losses and contacted manager for investigative assistance.
  • Worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Testified on behalf of agency as part of criminal and civic proceedings.
  • Established productive working relationships with public officials and law enforcement officers.
  • Handled Type calls from customers and other stakeholders about Type processes.
  • Verified accuracy of Type records to maintain accuracy of records database.
  • Evaluated original investigation reports and documents to resolve secondary concerns.
  • Negotiated Type settlement agreements to resolve disputes.
  • Directed claims negotiations within allowable limit of $Amount and supported successful litigations for advanced issues.
  • Managed a high volume of complex claims, effectively prioritizing tasks to ensure prompt resolution for clients.
  • Consistently achieved departmental goals for claim closure ratios and customer satisfaction ratings through diligent case management techniques.
  • Implemented cost containment strategies by proactively identifying opportunities for subrogation or third-party recovery in applicable cases.
  • Effectively managed risk exposure by reviewing policy coverage details and applying appropriate limits during the settlement negotiation process.
  • Acted as liaison between clients, carriers, and internal departments, ensuring clear communication channels throughout the claims process.
  • Collaborated with legal teams, medical professionals, and other stakeholders to gather necessary information for accurate claim assessments.

Senior Claims Examiner

Gallagher Bassett Services Inc.
07.2024 - 02.2025
  • Reduced claim resolution time by conducting thorough investigations and timely decisionmaking.
  • Enhanced customer satisfaction through prompt communication and comprehensive claim explanations.
  • Spearheaded process improvements that resulted in reduced backlog and faster claim settlements.
  • Reviewed policy coverage details meticulously, ensuring accurate determination of benefits payable in each case.
  • Handled high-profile cases professionally, maintaining confidentiality while achieving satisfactory resolutions.
  • Negotiated settlements with claimants, balancing fairness with fiscal responsibility to the company.
  • Streamlined claims processing by implementing efficient workflow procedures.
  • Established trust among clients by consistently delivering fair assessments of their insurance claims.
  • Coordinated with medical professionals to obtain necessary documentation for evaluating injury claims accurately.
  • Collaborated with legal counsel on complex claims, ensuring compliance with regulatory guidelines.
  • Maintained up-to-date knowledge of industry trends and legislative changes, ensuring accurate claim evaluations.
  • Prepared detailed reports on claim activity for management review, highlighting areas for improvement.
  • Mitigated company risk by identifying fraudulent activities and implementing preventative measures.
  • Contributed to company growth by consistently meeting or exceeding productivity targets without sacrificing quality standards.
  • Developed and maintained relationships with key stakeholders, fostering a cooperative working environment.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Consulted police and hospital records when needed.
  • Interviewed claimants and witnesses to gather factual information.
  • Examined photographs and statements.
  • Finalized Type files for insurance claim payment release.
  • Worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial.
  • Identified suspicious losses and contacted manager for investigative assistance.

Senior Claims Examiner

InterCare
02.2023 - 08.2024
  • Experience working with 4850, which includes AME, Resolution Management and IOD benefits for Injured on Duty cases.
  • Prioritized tasks based on their importance and urgency
  • Calculated benefit payments and approved payments of claims within a certain monetary limit.
  • Systematically eliminated the Statute of Limitation and other various deficiencies.
  • Called clients to gather and relay information and develop procedures to effectively eliminate losing claims.
  • Maintained a diary of workers' injury cases for filing claims. This requires frequent communication with clients, trust representatives, and co-workers to develop case information, exposure evidence, and settlement options.
  • Tracked cases, cured deficiencies, and served clients by assisting in resolving claims. I also worked on time-sensitive tasks that needed to be accurately done and coordinated projects across departments to ensure timely completion.

Senior Claims Examiner

AmTrust
05.2022 - 02.2023
  • Experience working with 4850, which includes AME, Resolution Management and IOD benefits for Injured on Duty cases.
  • Prioritized tasks based on their importance and urgency
  • Calculated benefit payments and approved payments of claims within a certain monetary limit.
  • Systematically eliminated the Statute of Limitation and other various deficiencies.
  • Called clients to gather and relay information and develop procedures to effectively eliminate losing claims.
  • Maintained a diary of workers' injury cases for filing claims. This requires frequent communication with clients, trust representatives, and co-workers to develop case information, exposure evidence, and settlement options.
  • Tracked cases, cured deficiencies, and served clients by assisting in resolving claims. I also worked on time-sensitive tasks that needed to be accurately done and coordinated projects across departments to ensure timely completion.

Senior Claims Examiner II

Keenan and Associates
02.2016 - 02.2023
  • Prioritized tasks based on both importance and urgency. Systematically eliminate Statute of Limitation and other various deficiencies Call clients to gather and relay information Develop procedures to effectively eliminate losing claims.
  • Worked on priority cases Maintained a diary of workers' injury cases for filing claims.
  • Required frequent communication with clients, Trust representatives, and co-workers to develop case information, exposure evidence, and settlement options Tracked cases, cured deficiencies, and served clients by assisting in resolving claims.
  • Provided productive feedback Audit claims and collected all information needed Claims Examiner and Asbestos Litigation Legal Assistant.

Senior Claims Examiner

Los Angeles Metropolitan Transportation Authority
01.2012 - 02.2016
  • Approved benefit payments as well as payment of medical and legal expenses.
  • Reviewed injury reports to determine compensability and computer reserves for anticipated cost on each claim.
  • Consulted with accounts, lawyers, and physicians to get expert evaluation; Negotiated claim settlements and recommended litigation when settlement cannot be negotiated.
  • Interrogated titles to property to determine validity and act as company agent in transactions with property owners.
  • Calculated benefit payments and approved payments of claims within a certain monetary limit.

Claims Examiner

State Compensation Insurance Fund
03.2000 - 01.2012
  • Promoted to Claims Examiner from Insurance Technician.
  • Placed facultative reinsurance of risks exceeding the reinsurance treaty capacity with the company.
  • Coordinated with the processing manager the processing of non-renewal and conditional renewal notices within the frame as required by the Department of Insurance.
  • Examined claims forms and other records contested to determine insurance coverage; collected evidence to support contested claims in court/hearings.
  • Interrogated titles to property to determine validity and act as company agent in transactions with property owners.
  • Calculated benefit payments and approved payments of claims within a certain monetary limit.
  • Analyzed information gathered by investigation and reported findings and recommendations.
  • Communicated with former associates to verify employment records and to obtain background information regarding persons or businesses applying for credit.

Certification

Self Insured State of CA

Timeline

Senior Claims Consultant

CCMSI
12.2024 - Current

Senior Claims Examiner

Gallagher Bassett Services Inc.
07.2024 - 02.2025

Senior Claims Examiner

InterCare
02.2023 - 08.2024

Senior Claims Examiner

AmTrust
05.2022 - 02.2023

Senior Claims Examiner II

Keenan and Associates
02.2016 - 02.2023

Senior Claims Examiner

Los Angeles Metropolitan Transportation Authority
01.2012 - 02.2016

Claims Examiner

State Compensation Insurance Fund
03.2000 - 01.2012

Similar Profiles

CREATE PROFILE
Antionette Vines