Tamela Jones

Experience

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  Claim Capabilities Inc

  Mar 1991 - Dec 1998

  Worker’s Compensation Claims Supervisor

  Managed a team of claims specialist to ensure proper quality assurance of claims. Handled all of the claims of the team that were litigated. Complete all reportable claims to upper management for settlement to limit the liability of the insured. Trained claims specialist on establishing proper reserves, filing the correct division forms and provided tools for the proper issuance of disability benefits bi-weekly.

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  Protegrity

  Dec 1998 - Jan 2003

  Worker’s Compensation Senior Claims Examiner

  Confirmed policy coverage's and directs acknowledgement of claims. Interpreted and make decisions using independent judgment on moderate-to-difficult claims, policy coverage's and determines if coverage applies to claims submitted. Investigate claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required. Analyze claims activity and prepares reports for clients/carriers and management. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements. Settle claims promptly with and without mediation and issues company drafts in payments for claims within authority limits. Develop subrogation and third party recovery potential and follows reclaim procedures. Show less

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  Dallas Fire Insurance

  Dec 2003 - Jun 2005

  In-House Dedicated Senior Florida Lead

  Confirmed policy coverage's and directs acknowledgement of claims. Interpret and make decisions using independent judgment on moderate-to-difficult claims, policy coverage's and determines if coverage applies to claims submitted. Investigate claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required. Analyze claims activity and prepares reports for clients/carriers and management. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements. Settle claims promptly and equitably and issues company drafts in payments for claims within authority limits. Develop subrogation and third party recovery potential and follows reclaim procedures. Trained claims specialist on establishing proper reserves, filing the correct division forms and provided tools for the proper issuance of disability benefits bi-weekly based on Florida Workers’ Compensation Act, Rules and Laws. Show less

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  Broadspire

  Jul 2005 - Mar 2015

  WC Senior Claims Examiner

  Confirmed policy coverage's and directs acknowledgement of claims. Interpreted and made decisions using independent judgment on difficult claims, policy coverage's and determines if coverage applies to claims submitted. Investigate claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required. Analyze claims activity and prepares reports for clients/carriers and management. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority. Identified subrogation and third party recovery potential and recovered monies due and owed. Analyze claims activities, prepared reports for clients, carriers and/or management. Participated in claim quarterly reviews.Texas Property & Casualty Insurance Guaranty AssociationDedicated Claims Adjuster IV Adjusting claims from the receiver of the insolvent and impaired estate. Review and authorized payment of pay all benefits per the Article 21.28C Show less

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  Cannon Cochran Management Services Inc

  Mar 2015 - Oct 2015

  Dedicated WC Senior Claims Examiner

  Confirmed policy coverage's and directs acknowledgement of claims. Interpreted and made decisions using independent judgment on difficult claims, policy coverage's and determines if coverage applies to claims submitted. Investigate claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required. Analyze claims activity and prepares reports for clients/carriers and management. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority. Identified subrogation and third party recovery potential and recovered monies due and owed. Analyze claims activities, prepared reports for clients, carriers and/or management. Participated in claim quarterly reviews. Show less

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  York Risk Services Group

  Oct 2015 - Dec 2018

  Dedicated WC Senior Claims Exminer

  Confirmed policy coverage's and directs acknowledgement of claims. Interpreted and made decisions using independent judgment on difficult claims, policy coverage's and determines if coverage applies to claims submitted. Investigate claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required. Analyze claims activity and prepares reports for clients/carriers and management. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority. Identified subrogation and third party recovery potential and recovered monies due and owed. Analyze claims activities, prepared reports for clients, carriers and/or management. Participated in claim quarterly reviews. Show less

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  Sedgwick

  Jan 2019 - now

  Senior Claims Examiner

  Confirmed policy coverage's and directs acknowledgement of claims. Interpreted and made decisions using independent judgment on difficult claims, policy coverage's and determines if coverage applies to claims submitted. Investigate claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required. Analyze claims activity and prepares reports for clients/carriers and management. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority. Identified subrogation and third party recovery potential and recovered monies due and owed. Analyze claims activities, prepared reports for clients, carriers and/or management. Participated in claim quarterly reviews. Show less