Workers Compensation Resume Sample
Anjali O'Conner
7170 Collier Hollow,
Los Angeles,
CA
+1 (555) 144 1725
Work Experience
Manager Workers Compensation
12/2016
-
PRESENT
Dallas, TX
- Administer, audit and provide interpretation of state/federal laws, Company leave of absence and disability policies to include Family and Medical Leave Act, ADA, USERRA and Worker’s Compensation regulations
- Identify and set-up clinics for purposes of injury/worker’s compensation cases in new work locations
- Knowledge of Workers’ Compensation law, rules and regulations
- Serves as the subject matter expert for the leave and workers’ compensation programs in alignment and under the general direction and guidance of HR leadership and the legal department
- Interprets and administers reasonable accommodation, leave programs and policies in accordance with the applicable federal and state employment laws (FMLA, ADA, USERRA, Pregnancy Discrimination Act, etc.)
- Acts as liaison to local management team regarding Workers Compensation ensuring that recordable injuries are accurately coded in the Company’s vendor system within 24 hours of the incident
- Provides extensive case management and coordinates administrative aspects of the cases and claims in accordance with applicable insurance policies, local, State and Federal regulations
- Works closely with the FMLA, STD, LTD and Workers Compensation vendors to ensure that pay for DPSG employees is accurate and timely
Workers Compensation Claims Consultant
11/2010
-
09/2016
Boston, MA
- Coordinate reporting and investigation of work injuries with Operations and Safety
- Report new work injuries to Third Party Administrator
- Monitor claim handling activity by Third Party Administrator
- Monitor, analyze, and report to internal client reserves and reserving activity (including reserving internally)
- Establish and maintain internal electronic files, including notes, records, statements, and correspondence
- Establish and monitor relationships with outside vendors and monitor expenditures for cost effectiveness
- Establish and monitor relationships with outside legal counsel and monitor expenditures for cost effectiveness
- Identify “best value” metrics in carriers and providers
- OSHA and various state-level compliance and including reporting, postings, panels, internal reporting, and other internal communication
Workers Compensation Claims Assistant
06/2004
-
08/2010
Chicago, IL
- Works closely with employees to ensure that all relevant completed medical documentation is submitted for timely review
- Maintains appropriate contact with all employees on leave and coordinates all aspects of return to work for employees on leave including reasonable accommodation
- Produces and manages reporting metrics and analytics for all leave cases and workers’ compensation claims. Presents reports as requested
- Partners closely with all HR business partners and legal team on reasonable accommodation, all leave cases and workers’ compensation claims
- Meets regularly with HR business partners and business partners to review claims’ status and develops strategies for resolution
- Assists in the creation and facilitation of leave administration, workers’ compensation training and safety training programs
- MS Office products
Education
Argosy University - Sarasota Campus
2000 - 2004
Bachelor's Degree in Business
Professional Skills
- Excellent communication skills. Experience and comfort level communicating with individuals at all levels
- Strong typing, ability to use computer software, excellent customer service and communication skills
- Strong organizational skills; effectively utilize diary system and document all activities
- Strong computer skills including Excel, Word, Outlook and Access
- Excellent persuasion and interactive skills in addressing interdepartmental Workers’ Compensation issues
- Strong negotiation, problem solving and conflict resolution skills
- Writing and oral speech skills
How to write Workers Compensation Resume
Workers Compensation role is responsible for training, computer, organization, basic, interpersonal, software, insurance, access, medical, litigation.
To write great resume for workers compensation job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Workers Compensation Resume
The section contact information is important in your workers compensation resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Workers Compensation Resume
The section work experience is an essential part of your workers compensation resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous workers compensation responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular workers compensation position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Workers Compensation resume experience can include:
- Strong mathematical calculating and computer skills
- Effective written and oral communication, interpersonal and listening skills
- Excellent verbal and written communication/customer service skills with ability to build long term rapport with client(s)
- Has strong computer skills and is able to utilize Microsoft Office products and insurance companies/TPA on-line claims administration systems
- Operate in a team environment with the expectation of enhancing and contributing to the offices overall effectiveness and success
- Solid experience working with TPA and insurance company claim systems
Education on a Workers Compensation Resume
Make sure to make education a priority on your workers compensation resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your workers compensation experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Workers Compensation Resume
When listing skills on your workers compensation resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical workers compensation skills:
- Proficient abilities to effectively operate a personal computer and related claims and business software
- Detail oriented with strong organization and time management skills
- Excellent time management, organizational, communication and computer skills
- Professional telephone demeanor and good oral and written communication skills
- Critical thinking and problem-solving skills to arrive at meaningful, lasting solutions
- Experience handling NJ Lost Time Workers Compensation Claims; 3+ years of experience in a TPA environment
List of Typical Experience For a Workers Compensation Resume
1
Experience For Manager Workers Compensation Resume
- Good telephone and typing skills required
- Critical thinking skills to assess compensability of WC claim as it relates to the facts and law
- Demonstrate strong technical and functional abilities in commercial claim adjusting and management
- Effectively monitors light duty programs
- Providing a cost effective, efficient, professional and customer focused service
- Knowledge of computer systems and applications. Skill in gathering and evaluating data
2
Experience For Workers Compensation Claims Manager Resume
- Five to seven years multi-state experience handling and supervising Workers’ Compensation claims
- Work independently with minimal supervision and to establish and maintain effective working relationships with clients
- Deliver in-house training programs designed to improve employee safety effectiveness (e.g., Body Mechanics, Forklift, Drug policy, OSHA compliance.)
- Related customer service experience or applicable insurance knowledge. Licensing required in some states
- Five to eight years of progressive experience handling Multi-State WC Claims
- Thorough and proven knowledge of standards, practices, procedures, and various laws applicable to adjusting WC claims
- Demonstrated success in managing a claims program that spans state lines
- Experience managing a Workers Compensation Claims Process in multiple states
- Previous experience working with workers’ compensation claims management processes and techniques
3
Experience For Workers Compensation Administrator Resume
- Previous workers’ compensation claim management, including employer administration experience
- Experience in a medical office setting is required
- Knowledge of insurance carriers & experience managing TPA’s is required
- Five (5) years of practical experience in Worker’s Compensation (Corporate, Insurer or Adjustor)
- Enters electronic data for experience modification, invoices, and others as needed
4
Experience For Workers Compensation Case Manager Resume
- Previous experience with worker’s compensation claims management desirable
- Communicate with Product Groups, medical staff, TPA, and associates to ensure effective WC treatment options
- Maintains positive attitude and demonstrate ability to be flexible in a rapid changing business environment
- Maintains effective communication with associates, third party carrier and or carrier representatives, managers, supervisors, and safety coordinator
- Establishing and developing relationships with new business prospects and existing clients
- Working knowledge of technical workers’ compensation and case law including monopolistic states, and non-subscriber associate benefit injury plans
- Liaising with injured workers, treating practitioners and external stakeholders regularly
- Willing to travel for mediations, if necessary
5
Experience For Workers Compensation Claims Unit Manager Resume
- Working with clients and their insurer to strategically manage and actively close workers’ compensation claims
- Utilizing all tools available, i.e. websites, CD’s, email, phone obtains all data pertinent to the determination of the financially responsible party
- Understanding and Commitment to HSE / OH&S principles
- Managing daily workflow to maintain service standards
- Filing of correspondence in workers compensation files on daily basis
- Understanding of injury prevention principles
- Providing National and State-based workers’ compensation claims, injury management and premium support and advice
- Working knowledge of medical treatment and terms as related to medical only workers compensation claims
- Processing of invoices/payroll
6
Experience For Manager, Workers Compensation Resume
- Assisting examiners with investigations and denials
- Managing losses in a risk management environment
- Working knowledge of ERISA/Self Insured plans
- Providing National and State-based workers’ compensation claims and injury management support and advice
- Manages, coordinates, and completes network referrals (within 48 hours), STAT referrals, obtaining claim information, and submitting referrals for scheduling
- Actively promoting the growth of the consulting practice by participating in Business Development activities
- Establish and develop work injury prevention programs, including with outside vendors and recruiting teams
- Troubleshoots and resolves incomplete referrals and coordinates with clinics for necessary records including correcting demographic information if needed
- Notifies billing and marketing departments of needed changes to client preference cards
7
Experience For Workers Compensation Claims Consultant Resume
- Coordinates seminar activities including invitations, RSVPs, and ordering food/beverages
- Ensure training meets standards for regulatory agencies including OSHA, FDA, and USDA and addresses LCME recommendations
- An understanding and commitment to injury management principles and the RTW process. (or the ability to acquire this understanding)
- Assist occupational health staff with understanding and directing worker’s comp cases
- Assist the claims adjuster with obtaining additional information for the service and handling of claim
- Provide direction to injured workers and supervisors regarding medical evaluation and treatment of any injuries ranging from First Aid to Advanced Life Support
- Arrange independent medical examinations, requesting treater reports, coordinating necessary treatment for injured workers
- Handles filing, faxes and photocopying
8
Experience For Claims Manager Workers Compensation Resume
- Other government reporting and legal compliance as required and needed
- Processes requests for additional information from clients regarding their employees
- Interprets laws ,regulations and polices to guide appropriate decision-making
- Directs the activities of outside claims adjusting services, insurers, and medical providers
- Guides manager involvement and decision-making on claim settlements and hearings
- Periodic client performance reporting on claims and premium
- Support all marketing exercises, to include requests for proposals (RFP’s), as necessary
- Prepares trend analysis reports using claim vendors systems and/or Excel spreadsheets
- Assists in assembly of marketing and presentation materials for distribution
9
Experience For Workers Compensation Claims Assistant Resume
- Performs electronic filing of data and reports
- Responsible for reasonable suspicion drug tests and processing
- Co-coordinate all safety-training activities for the Distribution Center
- Assist in training and operation of the CAM Program
- Participate in and coach Product Groups during WC Claims’ Reviews with TPA
- Verifies all insurance pertaining to the service date and that the appropriate guarantor is attached
- Basic understanding of injury prevention principles
10
Experience For Workers Compensation Claims Supervisor Resume
- Advises Manager and entity HR Directors of upcoming hearings and/or required phone interviews as requested by the state
- Aid the Occupational Nurse Manager in setting up doctor appointments
- Maintain accurate workers’ compensation records and reports to comply with federal and state record keeping requirements
- Contact treating physician to obtain work status and information on employee’s condition
- Act as first point of contact in the investigation and recording of work-related and non-work related injuries and incidents
- Follow up with injured workers to determine return to work status and ongoing treatment
- An understanding and commitment to injury management principles and the RTW process
- Some travel and/or long distance driving maybe required
- Coordinate insurance claims reporting to broker and insurer
List of Typical Skills For a Workers Compensation Resume
1
Skills For Manager Workers Compensation Resume
- Investigates, evaluates, disposes and settles less complex claims with moderate supervision and includes the investigation, determination and evaluation of coverage, liability and damages and the setting of proper reserves
- Experience and working knowledge of Florida Medical Only workers’ compensation claims
- Establish and maintain effective working relationships with clients
- Employee Health experience
- Clinical worker’s compensation or case management experience
- Consistent good attendance required
2
Skills For Workers Compensation Claims Manager Resume
- Develop and maintain working relationships with vendors (including nurse case management, attorneys, etc.)
- Work closely with Risk Management Analysts in developing reporting to measure performance
- Develop and maintain working relationships with the Third Party Administrator (TPA) and the claims insurance carrier
- Achieve and maintain working knowledge of Workers’ Compensation regulations in each of the 50 states, and the District of Columbia
- Develop and maintain a working relationship with our Work Comp insurance broker representative
- Incumbents at this level typically hold claims reserve and settlement authority from $10,000 - $50,000 or greater
- Knowledge of workers' compensation, labor code, OSHA regulations and other state and federal requirements
- Knowledge of state workers’ compensation law and practices
3
Skills For Workers Compensation Administrator Resume
- Knowledge of accepted industry standards and practices, along with ability to follow company and client policy and procedure
- 5-20 or 5-24 Florida state license required
- Overall enhance and develop programs to drive service up and costs down
- Assure that injured Team members receive swift and appropriate medical care
- Assure that claims are managed efficiently and results show constant progress
- Oversee the Stay At Work / Return To Work program
- Integrate closely with Risk Management Health and Safety consultants in the prevention of and response to injuries
- Coordinate and execute TPA and insurance carrier File Reviews
- Oversee the Narcotics Management program
4
Skills For Workers Compensation Case Manager Resume
- Oversee the management of the self-insured program in Ohio
- Oversee the management of the program in monopolistic states
- Oversee the review and authorization of payment of invoices from the TPA and Counsel
- Explore all opportunities to enhance the performance of the Workers’ Compensation program, and present proposals for program enhancement to the VP of Risk for consideration
- Ensures flawless and consistent execution of client service instructions and performance guarantees
- Actively review work of others via file reviews; identify coaching opportunities, act on needed coaching opportunities and position subordinates for successful development leading to advancement within the organization
- Able to multi-task, establish priorities, complete tasks/assignment timely and comply with process requirements
- Have experience in the application of workers compensation legislation and injury management principles
- Strong knowledge of York’s Best Practices and client Account Instructions
5
Skills For Workers Compensation Claims Unit Manager Resume
- Successfully negotiate the settlement and disposition of serious claims including the ability to interpret related documentation
- Responsible for maintaining regular communication with the injured worker, medical providers, attorneys, employers, claims professionals, and ECS management
- Accurately reports all case activity and billable hours in accordance with client-specific guidelines and consistent with company billing practices
- Advanced working knowledge of York’s claim system and internal workflows & procedures
- General knowledge of property and casualty claim handling practices
- General knowledge of practices and techniques related to investigations and fact finding
6
Skills For Manager, Workers Compensation Resume
- Interact and collaborate with internal and external business partners, including outside agencies
- Exceptional commitment to customer service
- Obtain and maintain the requisite security clearance for this role; and
- Implements, calculates and documents cost savings measures
- Develops guidelines for working with patients, healthcare management companies, insurance companies or other third party payers to determine quality, cost-effective care
- Arranges referrals, consultations, therapeutic services, and confers with other specialists regarding course of care and treatment
- Applies all special service instructions required by customers/accounts
- Appropriately applies all laws and regulations to the provision of rehabilitation services
- Evaluates outcomes and case goals
7
Skills For Workers Compensation Claims Consultant Resume
- Prepares reports and other required documentation for casework activities
- Upholds applicable state and federal regulatory requirements that govern workers' compensation disability
- Substantiates case activities carried out/services rendered in all activity reports completed
- Attends all scheduled conference calls as mandated by management
- Maintains any required credentials and adheres to all codes of ethics required by these credentials
- Insurance Claims Representatives work in a high-volume, fast-paced environment and are responsible for providing exceptional service to policyholders in response to a notice of loss
- Develop and implement division Workers’ Compensation processes and procedures in compliance with corporate and company policies
8
Skills For Claims Manager Workers Compensation Resume
- Proficiency with Microsoft Office applications and similar business software
- CUSTOMER FOCUS: Make internal and external customers, and their needs, a primary focus of one’s actions. Develop and sustain a productive department
- Hold responsibility for assigned team’s management of all assigned workers’ compensation claims and required activities including not only the legal requirements, but also abiding within the organization’s best practices
- Secure information and evidence from the operating business units regarding workers’ compensation claims
- Provides visibility to activities and trends by analyzing, summarizing, and reporting on key metrics
- Exercise initiative, problem solving, and decision–making
- Assists with investigation activities and helps with coordinating and overseeing vendor service partner activities in the field
- Successful project delivery, budgeting and insurance premiums management is critical
9
Skills For Workers Compensation Claims Assistant Resume
- Provide feedback and guidance to the team on achieving set goals
- Assist Settlement and Handicap analysts with achieving mandatory annual guidelines for private and public employers through system and process enhancements
- Develop and implement Quality Assurance standards for the team members to ensure department benchmarks are being achieved
- Provide reserve and settlement authority to TPA within designated limits, escalating all appropriate matters as required
- Monitor and report injury trends and assist developing appropriate interventions for illness/injury awareness, detection, prevention and early treatment
- Interact with Human Resources, Legal, Safety, Loss Prevention, Albertsons’ Companies stores/distribution/warehouse and plant locations and personnel
- Workers’ Compensation law; policies and procedures
10
Skills For Workers Compensation Claims Supervisor Resume
- Medical and legal terminology, Integration with Medicare
- In-depth knowledge of the California Labor Code for those Examiners in California, practices & procedures and current case law
- Experience in workers compensation claims management with specific experience in managing/leading a self-insurance portfolio, and/or of similar injury management experience
- Experience in people management within a workers compensation environment
- Conducts regular file reviews as required by York and Client Instruction/Best Practices; ensuring compliance with issuing and approving CMR’s as well as reviewing and approving all denials and reserves
- Possession of a California Self-Insurance Administrator’s Certificate
- Possession and maintenance of a valid California class C driver’s license and a satisfactory driving history as obtained from the Department of Motor Vehicles
- Appropriately licensed and certified in California
List of Typical Responsibilities For a Workers Compensation Resume
1
Responsibilities For Manager Workers Compensation Resume
- Demonstrated ability to prioritize and handle multiple tasks simultaneously
- Compile witness statements and incident reports into a consolidated file and update as necessary
- Recent Workers Compensation Claims experience
- Has 2-5 years of claims experience in liability lines of coverage
- Processing payments and ongoing payments, along with creating required DWC notices
- Providing documents to doctors, employees, employers, attorneys and ensuring they are filed correctly
- Setting up new workers compensation claims
- Creates various reports and presentation materials using pivot tables, charts and graphs
- Serves as a central point of contact regarding workers compensation claims for the company and any or all subsidiaries
2
Responsibilities For Workers Compensation Claims Manager Resume
- Monitor and analyze for excess claim reporting to identify trends and provide remediation recommendations
- Capable of lifting 15lbs
- Enjoys working in a fast-paced, high growth environment
- Trade association reporting
- Extensive knowledge within all aspects of adjusting Workers' Compensation Claims
3
Responsibilities For Workers Compensation Administrator Resume
- Familiarity with a university setting is helpful
- Coordinate department training sessions
- Work with retail and manufacturing management on Workers’ Compensation issues
- Learn while being exposed to a variety of different concepts
- High level of internal customer service to claim offices, claim professionals, Underwriting, Compliance, and external customers
- Advanced classes taken such as the IEA Labor Code and Case law, Advanced PD Rating or INS Supervisory classes or equivalent
- Adaptability in a changing environment and work under pressure
- Coordinate patient’s entry into and through the health care system as related to a patient’s disability claims
- Coordinate and Complete all paperwork and correspondence requirements related to patients’ medically-required absence from work or medically-required work restrictions (i.e. required absence from work post surgery or work restrictions post surgery)
4
Responsibilities For Workers Compensation Case Manager Resume
- Under general direction, using knowledge of hospital and clinic policies, facilitate communication between the Employment and Social Security Administrations, DSHS, Dept of Vocational Rehabilitation’s CRC, and/or Worker’s Comp Case Managers with the Orthopaedic Surgeons promoting care to patients
- Act as primary liaison between the hospital, the patient and family, the physician, and outside worker’s comp, disability, and/or employment agencies in regard to coordination of each patient’s disability claim or medically-required absence from work
- Initiate and manage the Company’s return to work programs including collaboration with field operations and development of metrics that measure the success of the program.
- Partner with business units and TPA to utilize all tools available for ‘Return To Work’ programs, nurse case management, etc.
- Uses various metric driven tools such as FOCUS, the Claim Operation Tool Kit to evaluate performance and identify problem areas in advance of them becoming service issues
- Ensures receipt and maintenance of appropriate licenses and/or certifications for themselves and all assigned staff for all states in which states are being handled
5
Responsibilities For Workers Compensation Claims Unit Manager Resume
- Communicates with clients, carriers and brokers in a professional, positive and proactive manner
- Works collaboratively across all internal departments
- Responsible for the claim unit’s compliance to regulatory requirements
- Act as an internal resource for Workers’ Compensation questions
- File BI indexes and PILR’s when possible
- Creative problem solver who can assist Crewmembers throughout the process while demonstrating a high level of sensitivity, empathy, and care that align with the Company’s values
- Administers subrogation of claims and negotiates settlements
6
Responsibilities For Manager, Workers Compensation Resume
- Compiles reviews and analyzes management reports and takes appropriate action
- Work occasional night/weekend as dictated by office needs
- Under general direction and oversight, conducts detailed analysis and completes timely investigations of suspected claim fraud by following Best Practice Guidelines and collaborating with insureds, claimants, witnesses and experts
- Learning to develop and execute investigation strategy by assessing the situation, collaborating with claim professionals, counsel, experts, insureds, and other stakeholders
- On appropriate cases, such as questionable "red flagged" cases, lost time cases, etc.
- Work with the Third Party Administrator (TPA) claims adjusters and Risk Management team to ensure proper and efficient handling of workers’ compensation claims in a multi-state environment; Charter operates in 41 states
- Review and assess subrogation potential of all workers’ compensation claims
- Attend or arrange for representation at trials or claims mediations, as needed
7
Responsibilities For Workers Compensation Claims Consultant Resume
- Coordinate with Environment, Health & Safety (EHS) policies and personnel to mitigate risk
- Designs and implements the most effective claims management structure, controls, programs, staffing (internal and external), including the company’s litigation strategies
- Develop proactive training programs for all levels of Team Members and managers and related vendors as needed to impact the cost and duration of claims to enforce the effectiveness of the company’s post loss strategies, including AAPs return to work program and claim allocation charges & credits
- Two to four years’ experience in an insurance claims department or related experience
- Workers Compensation: Currently 2 direct reports
- Refine/develop communication and response protocols, including an empathic view and advocacy methodology between Workers’ Compensation Team and the Crewmembers
- Define and prioritize service initiatives for the Workers’ Compensation Team to ensure expedited medical care and improved management of medical treatment
8
Responsibilities For Claims Manager Workers Compensation Resume
- Ad hoc Worker’s Compensation related projects as they arise
- Oversee ongoing training, development, and supervision of internal claims unit and develop and maintain written policies and procedures for both internal/external claims adjusters to ensure clearly defined responsibilities and standards for performance
- Manage external vendors in the areas of claims administration, managed care, and litigation through benchmarking, loss analysis, and general performance measurement reports to ensure adherence to best practices as well as company specific claim program goals, directives, initiatives, policies, and procedures
- Conduct and oversee all claim reviews and audits to ensure effective claims handling by internal and external adjusters
- Authorize Reserves and Settlements within established authority
- Manage collection of required regulatory and company specific claim related data to ensure compliance with all record keeping, reporting, loss forecasting, and loss analysis requirements
9
Responsibilities For Workers Compensation Claims Assistant Resume
- Assembles documents manually and electronically for distribution primarily from Word and Adobe (e.g., Best Bets, Injury & Illness Prevention Program, Claim kits, loss runs, policies, and endorsements)
- Generates recurring mail merge correspondence to customers
- Manages office supply inventory and provides clerical support to local business units
- Populates and maintains various claim and policy data onto Excel spreadsheets
- Receives assigned claims for medical and disability management
- Processes claims which include the following activities: set up file in ACS, establish initial reserves, analyze investigational data, settle claims, reserve claim for probable ultimate payout, explore subrogation potential, closes claims and secures appropriate releases
- Documents claims files and maintain control of work through documentation or diary system
10
Responsibilities For Workers Compensation Claims Supervisor Resume
- Assigns litigated claims to an attorney who manages defense claim
- File state forms timely in accordance with statutory guidelines
- Assign nurse case management or other experts to case and arrange when necessary
- Manages employee return-to-work program
- Conduct safety training needs assessment on an ongoing basis based on input from various sources, e.g., feedback from supervisors/managers & warehousemen/drivers, surveys and exit interviews
- Develop programs, procedures, and communications processes to ensure new distribution employees feel welcome, well trained, and well informed on safety issues
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