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Staff Spotlight: Claims Operations Manager Nikki Lawhon

Monday, September 17, 2018/Categories: Providers

Meet Nikki Lawhon, LWCC’s claims operations manager. Nikki has a broad background handling compliance auditing, Medicare, NCCI, recovery, fraud investigations and medical bill review. As if she didn’t have enough to do, Nikki also manages internal I.T. systems and interfaces required to run the claims division.

Nikki graduated from LSU with a bachelor’s degree in psychology with minors in Spanish and corrections. Nikki joined LWCC shortly after receiving her bachelor’s degree in 2004, as an associate claims representative. In this role, she learned the basics of workers’ compensation and handled all types of claims from simple medical-only claims to more complex lost-time claims. In 2006, she received her master’s in human resources and leadership development. In 2007, she transitioned to an investigative claims rep where she was responsible for investigating lost-time claims to determine compensability. One year later, Nikki moved to the operations side of the claims department as a technical specialist handling NCCI and Medicare compliance. In 2012, she was promoted to operations supervisor, and recently to operations manager.

Under Nikki’s direction, the claims operations team consists of several smaller teams that handle a variety of functions supporting the entire claims division. The intake team is responsible for receiving and setting up all the workers’ comp claims that LWCC receives. This team spends many hours on the phone with policyholders gathering information necessary for LWCC to investigate a claim. The medical bill review unit processes over 50,000 medical bills we receive annually. The special investigation unit (SIU) team is responsible for reviewing and investigating potential fraud by injured workers, policyholders or medical providers. Finally, the operations and technical specialists handle quality auditing, Medicare and NCCI compliance, I.T. system projects, as well as multistate and special claims. Managing such a diverse and challenging group of activities certainly keeps Nikki busy and engaged in every aspect of claims management.

So what’s next for Nikki and her teams? Having to interface with outside entities such as NCCI and Medicare brings new challenges almost every year, and we expect this to continue for the foreseeable future. No doubt the biggest challenge on the horizon for the operations team is the implementation of a new core computer system over the next year or so. Every system function at LWCC will be impacted by this change, and Nikki is integrally involved in many parts of this project. In addition, every day, claims have to be received and set up, medical bills have to be paid, and we must stay in compliance with outside regulatory entities. But no one is more capable of helping keep us on track than Nikki.

Of course, Nikki does have a life outside of her role at LWCC! She is married to her husband, Blake, and she is mother to 3-year-old Leah and 5-month-old Adalyn. “Leah and Adalyn keep me very busy and active,” says Nikki. “Leah’s favorite things to do on the weekends are arts and crafts, going to the Knock Knock Museum and dressing up as princesses and superheroes. Adalyn has found her voice and loves to talk to us in what we call “Pterodactyl” speak (but high pitched and girly). Adalyn loves playing with her feet and interacting with her big sister.

“When I’m not in ‘Mom mode,’ I enjoy relaxing with a good book. Right now that good book is What to Expect the First Year!”
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