Sergio E.

Espinoza, WCCP
58 Iron Horse Lane
Walnut Creek, CA 94597
mobile 510.918.3831 | home 925.296.6115
serspinoza@hotmail.com

Objective: To secure a Benefits and Workers’ Compensation Specialist position,

with an innovative company and administer benefits in a timely, professional
manner to nurture the opportunity for managerial advancement within a
professional human resources team.

Experience – 20 years adjusting Workers’ Compensation claims.

FARMERS INSURANCE EXCHANGE - Pleasanton, CA

Sr. Claims Adjuster 2008 - 2010
Handled all aspects of California Workers’ Compensation claims.
Adjusted northern and southern California claims for a large number of
small business policyholders, and delivered timely claim status to the
client and respective agent.
Investigated assigned claims to determine compensability and evaluate
claim exposure to establish reserves.
Developed claim strategies to drive claims to forecasted results and timely
closure.
Controlled medical treatment and scheduled medical-legal evaluations,
where appropriate.
Adjusted and settled a number of litigated claims in propia persona.

MAJESTIC INSURANCE COMPANY – San Francisco, CA

Sr. Claims Adjuster 2007 - 2008
Handled all aspects of California Workers’ Compensation claims.
Adjusted and settled claims from inception to resolution.
Serviced 75 active small business policies.
Maintained open lines of communication with insured, attorneys and
claimant to
keep all parties informed and reach prompt claim resolution.

PREFERRED EMPLOYERS INS. CO. – Walnut Creek, CA

Sr. Claims Adjuster 2005 - 2007
Handled all aspects of California Workers’ Compensation claims.
Conducted recorded investigations in English and Spanish, to determine
claims compensability and reserves exposure.
Generated and delivered timely claim status reports to producers and
policyholders.
Adjusted and settled a large percentage of litigated claims, without
defense counsel.
INNOVATIVE CLAIM SOLUTIONS (Third Party Administrator) – San Ramon, CA
City of Berkeley Claims Adjuster / Supervisor 2003 - 2005
Supervised a team of five employees: four Claims Examiners: two Junior-
level adjusters, one Mid-level adjuster, one Senior-level adjuster, and one
Claims Assistant.
Adjusted complex claims, and handled all aspects of California Workers’
Compensation claims.

AMERICAN INTERNATIONAL GROUP INC. (AIG) – San Ramon, CA

Sr. Claims Adjuster 2000 - 2003
Handled all aspects of California Workers' Compensation claims.
Adjusted claims from inception to resolution.
Serviced and adjusted claims exclusively for dedicated construction
account: Walter's & Wolf in Fremont, CA.
Prepared and delivered quarterly claim status reports to brokers and
dedicated account.

Work history prior to 2000, is available upon request.

EDUCATION & TRAINING:

Recent training Topics:
Benefit Notices; Seminar on the latest Health Care issues in Sacramento,
Ca. and their affect on the Workers’ Compensation system; Permanent
Disability rating guidelines changes; Current related litigation en banc
decisions; Indemnity Benefits rate increase; American Disability Act and
its effect on future litigation in the WC system; Mandated Annual Fraud
training (2009); Alternate Dispute Resolution (ADP) process; Medicare as
second payer (2010).
Bachelors of Science (BS) - 2000 – University of Phoenix San Jose Campus, Ca.
Workers' Compensation Certified Professional (WCCP) - 1997 - IEA San
Francisco, Ca.
State of California Self-Insurance Certification (SIP) - 1997 - IEA San Francisco,
Ca.

SKILLS
I have excellent investigation, negotiation, and legal claim resolution skills.
I am bi- cultural and have sensitivity for Latin American clients.
I am multi-lingual and possess excellent written & verbal communication
skills in English, Spanish and French.
I have outstanding interpersonal and customer service skills developed
upon entry to the job market as a sales associate for Nordstrom.
I am proficient in most system applications, PC and MAC versions.

All references will be furnished upon request.