Gayle Ventus
Los Angeles
Summary
Dynamic Sr. Workers Compensation Claims Examiner with extensive experience, adept at claims adjustment and medical treatment authorization. Proven track record, leveraging strong analytical skills and effective communication to resolve complex claims efficiently. Committed to excellence in California workers compensation compliance.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Sr. Wokers Compensation Claims Examiner
Athens Administrator
Concord
07.2024 - 06.2025
- Control and resolve third-party administered workers compensation claims.
- Authorize appropriate medical treatment, beyond first aid using utilization review protocols.
- AOE/COE determination, and investigation.
- Pay benefits in a timely manner.
- Rating of permanent disability.
- Adjust/Adjudicate claims per California Workers Compensation Law
Sr. Workers Compensation Claims Examiner
Intercare Holdings Insurance
Glendale
03.2023 - 06.2024
- Control and resolve third-party administered workers compensation claims.
- Authorize appropriate medical treatment, beyond first aid using the Utilization Review process.
- AOE/COE determination and investigation.
- Pay benefits timely
- Rating of permanent disability
- Prepare reports for file reviews
- Set and conduct interactive meetings with employer and employees to answer questions and resolve questions regarding the workers compensation claims process.
- Adjust/Adjudicate claims per California Workers Compensations Law
Sr. Workers Compensation Claims Examiner
AmTrust Financial
Irvine
06.2022 - 02.2023
- Control and resolve insured workers compensation claims.
- Authorize appropriate medical treatment, beyond first aid using the utilization review process.
- AOE/COE determination, and investigation.
- Pay benefits in a timely manner.
- Rating of permanent disability
- Adjust/Adjudicate claims per California Workers compensation Law.
Sr. Workers Compensation Claims Examiner
Keenan & Associates
Torrance
04.2015 - 06.2022
- Control and resolve third-party administered workers compensation claims.
- Authorize appropriate medical treatment, beyond first aid using the utilization review process.
- AOE/COE determination, and investigation.
- Pay benefits in a timely manner.
- Rating per permanent disability.
- Prepare reports for reinsurance reimbursement request.
- Prepare reports for file reviews.
Workers' Compensation Claims Adjuster
Metropolitan Transportation Authority
Los Angeles
04.2012 - 04.2015
- Control and resolve self-insured workers compensation claims.
- Authorize appropriate medical treatment, beyond first aid using the utilization review process.
- AOE/COE determination and investigation.
- Pay benefits in a timely manner
- Rating of permanent disability
- Adjust/Adjudicate claims per California Workers Compensation Law
Workers' Compensation Claims Adjuster "C"
State Compensation Insurance Fund, SCIF
Glendale
02.2001 - 03.2012
- Control and resolve insured workers compensation claims.
- Authorize appropriate medical treatment beyond first aid using the utilization review process
- Pay benefits timely
- Rating of permanent disability
- Trained in interoffice / peer individual workstation ergonomics evaluation
- Adjust/Adjudicate claims per California Workers Compensation Law
Education
Communications
California State University, Dominguez Hills
Carson, CA05-2000
Associate of Arts - General Studies
El Camino College
Torrance, CA05-1995
Skills
- Claims adjustment
- Utilization review
- AOE/COE determination
- Medical treatment authorization
- Permanent disability rating
- California workers compensation
Certification
- California Self-Insured Administrator (SIP). 7/19/2013
Timeline
Sr. Wokers Compensation Claims Examiner
Athens Administrator
07.2024 - 06.2025
Sr. Workers Compensation Claims Examiner
Intercare Holdings Insurance
03.2023 - 06.2024
Sr. Workers Compensation Claims Examiner
AmTrust Financial
06.2022 - 02.2023
Sr. Workers Compensation Claims Examiner
Keenan & Associates
04.2015 - 06.2022
Workers' Compensation Claims Adjuster
Metropolitan Transportation Authority
04.2012 - 04.2015
Workers' Compensation Claims Adjuster "C"
State Compensation Insurance Fund, SCIF
02.2001 - 03.2012
Communications
California State University, Dominguez Hills
Associate of Arts - General Studies
El Camino College
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