Nina Drake Stevenson
Roseville
Summary
Senior Claims Professional with robust experience in evaluating and processing complex insurance claims. Skilled in risk assessment, policy interpretation, and ensuring compliance with industry standards. Strong focus on team collaboration and achieving optimal results, adaptable to evolving business needs. Known for reliability, analytical thinking, and effective communication.
Detail-oriented Examiner with 30 years of experience. Strong command of conflict resolution and negotiation combined with excellent reporting and research skills. Thorough understanding of claims process in the area of Workers Compensation.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Sr. Claims Examiner
Contra Costa County Schools Insurance Group
01.2024 - Current
- Handled a litigated caseload for a dedicated account
- Administered WC Benefits for two dedicated School District Account
- Calculated temporary and permanent disability payments and awards
- Worked closely with Workers Compensation Coordinator with return to work and updated medical status
- Reviewed and managed reserves on high-cost claims
- Maintained daily diary for review of incoming medical and return to work status updates
- Followed Utilization Review guidelines for all medical request per client guidelines and procedures in a timely manner
- Worked closely with attorneys, nurse case managers, doctors, in bringing the employees back to work, and resolving cases through settlement or closure
- Reduced claim resolution time by conducting thorough investigations and timely decisionmaking.
- Played an integral role in upgrading company software systems to streamline daily operations efficiently.
- Managed a team of junior examiners, providing guidance and training for improved productivity.
- Coordinated with medical professionals to obtain necessary documentation for evaluating injury claims accurately.
- Prepared detailed reports on claim activity for management review, highlighting areas for improvement.
- Maintained up-to-date knowledge of industry trends and legislative changes, ensuring accurate claim evaluations.
- Mitigated company risk by identifying fraudulent activities and implementing preventative measures.
Sr. Claims Examiner
LWP Claims Solutions
08.2023 - 01.2024
- Currently managing a dedicated City Account (Police & Fire Fighters)
- Administer 4850/Salary Continuation Benefits
- Worked closely with Workers Compensation Coordinator with return to work and updated medical status
- Calculate and draft Settlement Request for Claim resolution of PD Award & FMC Awards
- Reviewed and managed reserves on high-cost claims
- Maintained daily diary for review of incoming medical and return to work
- Followed Utilization Review guidelines for all medical request per client guidelines and procedures in a timely manner
- Worked closely with attorneys, nurse case managers, doctors, in bringing the employees back to work, and resolving cases through settlement or closure
- Facilitate Weekly meetings with City Risk Manager, Risk Analyst and Payroll Department
Sr. Claims Examiner
Keenan & Associates
08.2014 - 08.2023
- Manage lost time claims from inception to settlement resolution or closure
- Administer benefits of temporary and permanent disability, SJDB benefits, medical treatment in compliance with the CA State Workers’ Compensation Laws and company guidelines
- Prepare claims defense to mitigate liability by effectively using defense medical evaluations, QME, AME, investigations, depositions, and to pursue subrogation where applicable
- Review files every 30 days, addressing reserves, mail, issue identification, strategy development, and settlement valuations to bring claims to resolution
- Ability to negotiate and settle out complex cases with multiple issues
- Work closely with Insured’s, Brokers, Employees, and Defense Attorney’s for the purpose of bringing the case to resolution in a timely manner that’s cost effective for our clients
- Develop and present claims Summaries for Quarterly Claims Review with Clients
- Review and rate final reports for settlement of permanent disability, work restrictions and future medical care
- Participate in negotiation process by attending hearings and providing deposition and testimony to ensure cost effective resolution of each case
Education
High School Diploma -
Luther Burbank High School
Sacramento, CA06-1981
Skills
- Claims analysis
- Coverage Evaluation
- Investigation techniques
- Policy Interpretation
- Litigation Management
- Reserves Management
- Claim Resolution
- Claims Processing
- Data Verification
- Disability processing
- Time Management
- Claims Investigation
- Decision-making skills
Certification
- WCCA
- SIP
- Claims Adjuster Designation
Additionalworkexperience
Can be provided under separate cover outlining my Workers Compensation Work History from November 2013 to April 1996.
Timeline
Sr. Claims Examiner
Contra Costa County Schools Insurance Group
01.2024 - Current
Sr. Claims Examiner
LWP Claims Solutions
08.2023 - 01.2024
Sr. Claims Examiner
Keenan & Associates
08.2014 - 08.2023
- WCCA
- SIP
- Claims Adjuster Designation
High School Diploma -
Luther Burbank High School
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