BRITNEY FRESCO

[email protected] • (845) 743-3555 • Edison, NJ

PROFESSIONAL SUMMARY

Workers’ compensation professional with 8 years of experience managing high-volume Medical Only and Lost Time claims within TPA and insurance carrier environments. Experienced in full-cycle claims handling including investigation, compensability determination, reserve analysis, return-to-work coordination, and litigation exposure management across NJ and PA jurisdictions. Proven ability to manage large caseloads, ensure regulatory compliance, improve workflows, and drive efficient claim resolution.

WORK EXPERIENCE

WC Lost-Time Claims Examiner II
01/2023 - Present
AmTrust North America , Princeton, NJ
• Managed a high-volume caseload of 135 lost-time workers’ compensation claims across New Jersey and Pennsylvania, ensuring compliance with jurisdictional deadlines and statutory requirements while consistently achieving 95%+ audit scores.
• Conducted comprehensive claim investigations, including recorded statements, wage verification, medical record review, ISO searches, and SIU referrals to evaluate compensability and exposure.
• Established and adjusted claim reserves based on ongoing exposure analysis, maintaining accurate probable ultimate cost projections throughout the claim lifecycle.
• Collaborated with medical providers, nurse case managers, employers, and injured employees to determine causality, coordinate treatment plans, and support timely return-to-work outcomes.
• Directed litigation management on contested claims by partnering with defense counsel to develop strategy, negotiate favorable settlements, and minimize legal and indemnity exposure.
• Prepared and submitted state-required forms and EDI transactions within mandated timeframes, ensuring regulatory compliance and improving operational efficiency.
• Contributed to an 80% team closure ratio through proactive claim management, timely investigations, and strategic resolution planning.
Stay-At-Home-Parent | Family Manager
10/2019 - 09/2022
Self-Employed , New Jersey
• Managed full-time caregiving responsibilities for five children during the COVID-19 pandemic, including coordinating virtual learning, scheduling, and daily household operations.
• Oversaw household budgeting and expense management, reducing monthly costs through strategic financial planning and resource allocation.
• Maintained strong organizational and time-management skills by coordinating appointments, educational activities, and multi-person schedules in a fast-paced environment.
WC Lost-Time Claims Examiner I
03/2019 - 12/2019
AmTrust North America , Princeton, NJ
• Selected to participate in a two-week intensive workers’ compensation training program in Ohio focused on lost-time claim handling, jurisdictional procedures, reserving practices, and litigation management.
• Managed Temporary Total Disability (TTD) and Permanent Partial Disability (PPD) transfer claims while progressively assuming ownership of new lost-time files, consistently receiving approximately three new claims weekly.
• Successfully advanced from Lost Time Claims Trainee to Lost Time Claims Examiner I within two months based on demonstrated claim-handling proficiency and performance.
• Built and maintained a caseload of up to 120 lost-time claims across New Jersey and Pennsylvania while ensuring compliance with jurisdictional requirements and internal handling standards.
• Developed foundational expertise in reserve analysis and probable ultimate cost evaluation to accurately assess claim exposure throughout the claim lifecycle.
• Gained hands-on experience managing claims through the full litigation process, including coordinating with defense counsel, reviewing medical documentation, evaluating exposure, and supporting resolution strategies in both jurisdictions.
WC Medical Only Claims Supervisor
08/2015 - 04/2019
AmTrust North America , Princeton, NJ
• Supervised a team of six Medical Only workers’ compensation adjusters handling claims across New Jersey, Pennsylvania, Delaware, Washington, DC, and Maryland, ensuring compliance with jurisdictional requirements and internal claim-handling standards.
• Led onboarding and integration efforts following the acquisition of AmeriHealth employees, providing training and operational support to newly hired adjusters and incoming Lost Time managers.
• Developed and implemented Medical Only claim-handling guidelines to standardize workflows, improve consistency, and support operational efficiency across the department.
• Oversaw employee performance management, including coaching, auditing, productivity monitoring, performance improvement plans, and corrective action processes.
• Managed recruitment, interviewing, onboarding, scheduling, PTO coordination, and staff development to maintain team productivity and coverage.
• Facilitated weekly team strategy meetings to address workload distribution, complex claims, escalation opportunities, and employee concerns while driving productivity improvements through data-informed decision-making.
• Provided ongoing training and licensing support to adjusters, reinforcing jurisdictional knowledge, claim-handling best practices, and professional development.
WC Medical Only Claims Adjuster
08/2014 - 10/2015
AmTrust North America
• Assessed coverage and severity for new claims, ensuring compliance with Medicare and state reporting requirements
• Streamlined file management and communication, maintaining adherence to jurisdictional guidelines
WC Medical Only Claims Adjuster
07/2013 - 07/2015
Qual-Lynx , Piscataway, NJ
• Managed an average caseload of 350 Medical Only workers’ compensation claims across New Jersey and Pennsylvania, overseeing medical exposure while ensuring compliance with jurisdictional requirements and internal claim-handling standards.
• Conducted claim investigations, reviewed medical documentation, evaluated compensability, and coordinated treatment plans to support timely claim resolution and return-to-work outcomes.
• Worked proactively with claimants, employers, and medical providers to facilitate return-to-work efforts before jurisdictional waiting periods were met, helping to mitigate indemnity exposure.
• Identified and escalated claims involving potential litigation exposure, pre-existing conditions, compensability concerns, or lost-time eligibility based on jurisdictional waiting periods.
WC Technical Claims Assistant
01/2012 - 07/2013
Qual-Lynx
• Processed and set up new workers’ compensation loss reports, establishing complete and accurate claim files within a paper-based intake system.
• Redesigned loss data entry workflow, improving accuracy and efficiency across departmental operations.
• Supported invoice processing and provided general clerical and administrative support across the workers’ compensation department.
• Assisted with testing and implementation of the IVOS Claims System, identifying workflow issues and supporting system improvements.
• Trained colleagues on new system functionality and updated intake procedures to support successful adoption and consistency.

EDUCATION

High School Diploma
06/2009
Edison High School , Edison, NJ

SKILLS

Technical Skills: Workers’ compensation claims handling (Medical Only, Lost Time) Multi-jurisdiction claims experience (NJ, PA, DE, DC, MD) High-volume caseload management Claims investigation and compensability analysis Reserve setting and exposure evaluation Return-to-work coordination and indemnity mitigation Litigation awareness and file escalation Team leadership and performance management Training, onboarding, and staff development Workflow and process improvement Claims system experience (IVOS Claims System) Strong organization and time management Cross-functional communication

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