Alternate Dispute Resolution Adjuster/Sr. AB Adjuster Resume

Desired Industry: Insurance	SpiderID: 17613
Desired Job Location: London, Ontario	Date Posted: 12/9/2007
Type of Position: Full-Time Permanent	Availability Date: January 1, 2008
Desired Wage: 75,000
	U.S. Work Authorization:
Job Level: Experienced with over 2 years experience	Willing to Travel:
Highest Degree Attained: Other	Willing to Relocate: Yes

Objective:
My greatest strength lies in my ability to communicate with all types of people and different levels of professionals. Being able to analyze, identify and reserve potential exposures for catastrophic injuries. I have gained experience of Bill 59 and 198 accident benefit legislation.

Experience:
2002 to Present Senior Claims Representative ING Insurance Company ▪ London, Ontario

* Appraise/scope, confirm coverage, negotiate settlement, mediations, conduct reporting and documentation of senior claims of larger size with medical complexity in accordance with established guidelines. Strategized with ING lawyers on Arbitrations, Statement of Claims, FSCO Mediations
* Conduct basic investigations and obtain the required documentation necessary to support claims in accordance with company policy, as well as, provincial regulations, SABS
* Coordinate medical, income, and other necessary assessments with vendor program and reviews
* Investigated, negotiated, mediated and settled accident benefits claims including determination of priority of payments, assessments and calculation of benefit entitlements
* Adjusted AB claims as per the Statutory Accident Benefits Schedule and identified reserve exposure
* Authorized requests and issued payments in compliance with the SABS
* Monitored rehabilitation programs and assessed ongoing entitlement to benefits related to SABS
* Assisted, mentored, delivered support and technical expertise in Bill 59 and 198 accident benefits
* Identified collateral benefits (STD, LTD, WSIB, CPP, Group Benefits) to reduce exposure

2001 to 2002 Benefits Consultant DCAS University of Toronto ▪ Toronto, Ontario

* Produced comprehensive manual for DCAS and Human Resources on policy procedures
* Strategized as internal contact with insurance carrier on return to work initiatives, obtained/interpreted
medical information and organized return to work programs
* Liaised with HR, Union Representatives, Labour Relations and Department Heads to coordinate efforts
to monitor employee medical absenteeism and identify employment alternatives which resulted in
$100,000 savings to Facility and Services
* Developed presentations for Department(s) and Human Resources on accommodations, WSIB, LTD and medical leave to promote awareness of Special Needs
* Devised and implemented statistic record keeping at UofT to compile and prepare data on accommodation, return to work on Short Term, and LTD policy inquiries
* Created strong partnerships with Human Resources, Labour Relations, Departments and employees by
initiating team approach on early intervention and long term absence resulting in reduction of lost time

1998 to 2001 Long Term Disability Claims Adjuster SunLife Financial ▪ Toronto, Ontario
Long Term Disability Claims Adjuster Manulife ▪ Kitchener, Ontario

* Demonstrated efficiency in processing complex medical claims, identifying return to work and
rehabilitation programs resulting in awareness and effective strategies for return to work
* Caseload consisted of Chronic Pain Syndrome, Psychological, Fibromyalgia, Complex Physical Ailments
* Managed employee claims for obtaining medical information to identify capability of modified work, accommodation requirements and return to work programs
* Managed employee claims for administration of LTD claims with insurance carrier, this involved daily
contact to inquire on level of disability, identify work readiness, establish return to work programs, monitor costs of claim and determine external rehabilitation
* Directed inquiries on recurrences, appeal procedures and interpretation of the LTD contract
* Collaborated with Employers on file recommendations (i.e., UofT, City of Toronto, School Boards)
* Received intensive training on interpretation of medical documentation for the purpose of claims management
* Interacted with Orthopedic Specialist, Surgeon and Psychiatrists for medical clarification
* Monitor contracts and policy to determine entitlement and eligibility for ongoing benefits

1990 to 1998 Senior Claims Adjudicator, WSIB ▪ London, Ontario

* Participant in an intensive 8 week in-house training program on adjudication, Act and policies/procedures
* Thorough comprehension of legislation, statutory laws and ability to apply protocols and policies
* Planned, coordinated and determined eligibility through exploration of claim and application of policies
i.e. �Benefit Of Doubt�
* Caseload consisted of Ford, GM Locomotive, University Hospital, Parkwood Hospital, Nursing Homes and small businesses
* Liaised with Employers, Employees, Unions, Physicians and Vocational Consultants to arrange JSA, PDA,
Ergonomic Evaluations to assist claimant in safe RTW and/or potential for modified work per WSIB Act
* Toured factories, hospitals and nursing homes for purpose of identifying essential duties of jobs performed

Education:
CLAIMS MANAGEMENT DIPLOMA Fanshawe College, London, Ontario, 2000
(3 year diploma combining Claims Management and Medical education)

Skills:
SUMMARY OF QUALIFICATIONS
� 19 years benefits experience of Sr. Claims Management at WSIB, LTD, STD, Casualty Claims & HR
� Track record of promotions reflecting skills and performance while managing accounts between $3 to $5 million dollars
� Interfaced, planned and negotiated with all levels of management, including Directors, Human Resource Generalists, Lawyers, Physicians, Vendors, Corporate Managers, Vice Provosts, Professors
� Solid adjudication background in internal/external strategizing resulting in effective claims management skills to ensure fair resolutions and reduce financial exposure
� Strong analytical abilities in identifying and reserving potential exposures for Catastrophic injuries
� Achieved out-come oriented results such as implementation of early intervention strategies and return from Short Term and Long Term Disability (LTD) including WSIB return to work (RTW)
� Demonstrated strong adjudication tactics by reducing, for example, a major AB file by $2.5 million
� Strategized return to work initiatives, organized/interpreted medical information for RTW programs
� Successfully facilitated various seminars for WSIB and LTD to reduce exposure
� Effectively liaised with School Board personnel and insured�s lawyer to implement Educational Assistant services funded through the Board thereby protecting children�s limits for future needs
� Professional and practical experience working with clients of vulnerable populations addressing community reintegration, social integration, academic and avocational/vocational pursuits
� Facilitated EAP, Labour Relations in community safety on violence in the work place

Additional Information:
PROFESSIONAL DEVELOPMENT

St. Joseph�s Health Care Credited Course (Medicolegal Update), MRI Seminars (2), Behaviour Management, Effective Communication, Service Excellence, Self Discipline & Emotional Control, Steward I&II Ontario Federation of Labour, Violence in the Workplace, Crisis Intervention, Stress Management, Labour Law, Excel, Smart Simple, Payment Systems, Word Perfect

Reference:

1. Linden Rees, Owner
National IME Centres Inc.
(905) 889-9035

2. Tish Bryne, Manager
Bartimeaus Inc.
(905) 627-8368

3. Tina Feoli
Feoli Consultants
(519) 653-2498

4. Louise Oliver, HR Generalist
University of Toronto
(905) 569-4926

5. Christopher Lang, Manager Labour Relations and Barrister
University of Toronto
(416)946-7186

6. Anna Maria Petrone, Disability & Benefits Consultant
University of Toronto
(416) 978-2149

7. Talaal Bond, Barrister
Brown Beattie O�Donovan LLP
(519) 679-0400

8. Eugenia Bejgu, Case Manager
Medisys Health Group
(416) 926-6464 Ext. 2625

Candidate Contact Information:

Name: Diane Reid
Street: -	Phone: 519-438-4709
City: London	Fax: -
State: Ontario
Zip: N6B 2Z5
Web Site: