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Jessica Claire
Montgomery Street, San Francisco, CA 94105
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Executive Profile

Energetic and enthusiastic insurance professional motivated to succeed in a fast-pasted and deadline-driven professional environment. Comprehensive knowledge of workers compensation claims operations with concentration in medical bill review, new claims intake, training, quality and compliance.

Skill Highlights
  • Leadership
  • Self-motivated
  • Business operations
  • Problem-solving
  • Communication
  • Collaborative
  • Customer-oriented
  • Organization
Core Accomplishments

Medical Bill Review Transition:

  • Served as business lead for a medical bill review transition from service bureau to an application service provider (ASP) model resulting in $4m annual enterprise expense savings.

Improved Medical Bill Review Operational performance

  • Developed dedicated and specialized staff to support medical bill review performance which includes: medical bill review and compliance advisor, medical bill review trainer and medical bill review quality specialists to support operations which processes excess of 500k bills with north of $5m in charges.
  • Enhanced operations to improve use of pathway rule logic, performance oversight via letters of authority and vendor oversight
  • Developed trending tool to support performance oversight

Quality and Compliance Program Improvements/Development:

  • Continue to mature claims quality program used to evaluate claims outcomes and adherence to enterprise standards and practices.
  • Provide dedicated support to communicate regulatory changes as well as execute jurisdictional compliance audits to evaluate adherence to regulatory expectations.
  • Support and provide oversight of the brand's plans of actions to drive quality and compliance improvements



Professional Experience
09/2011 to 2016
Director, Corporate Claims, Enterprise Services Meadowbrook Insurance Group, Inc. Grand Rapids, MI,
  • Responsible for corporate claim support and oversight of: Accident Fund, United Heartland, Third Coast Underwriters and CompWest.
  • Provide senior leadership for medical bill review, intake, training, quality, compliance and claim support.
  • Responsible for collaborative advancements and resolutions in accordance with a Collective Bargaining Agreement.
01/2011 to 09/2011
Director, Claims Strategy Liberty Mutual Chattanooga, TN,
  • Responsible for creating a competitive advantage for United Heartland by the implementation of a client service/management strategy.
  • Responsible for implementation of a Risk Management Information System (RMIS) to expand premium opportunities.
  • Responsible for building and monitoring of metrics via scorecards/dashboards, workflow improvements and employee councils.
  • Provide senior leadership for the training and quality, medical billing, support services and client service specialists.
09/2007 to 01/2011
Manager, Claims Operations United Heartland City, STATE,
  • Developed and provided senior leadership of UH's Claims Operations team.
  • Identified, developed, documented and implemented workflow and technical improvements to support UH's key results.
  • Designed and implemented the Claims Audit Tool allowing for detailed analysis of claims staff performance.
  • Manager, Claims Training/Quality - United Heartland, New Berlin WI.
09/2004 to 09/2007
Manager, Claims Training and Quality United Heartland City, STATE,
  • Developed training programs for all claim staff as well as an Accelerated Training Program to expedite development of entry level claim professionals.
  • Management responsibility for accurate and prompt indemnity payments processing and statutory filings.
  • Responsible for claim audit execution to ensure work product and service aligned with expectations and best practices.
01/2003 to 10/2004
Workers Compensation Senior Claims Representative United Heartland City, STATE,
  • Managed and maintained key account relationships.
  • Applied expertise in daily processing of a wide variety of complex claims.
  • Managed and processed both worker's compensation and short-term disability claims through the United 24 Program as a Integrated Benefits Representative.
04/2002 to 01/2003
Workers Compensation Claims Representative III United Heartland City, STATE,
  • Managed and serviced large accounts.
  • Exercised authority in claims processing, settlement and resolution.
04/2000 to 03/2002
Workers Compensation Claims Representative II United Heartland City, STATE,
  • Responsible for account management and individual claim exposures.
  • Processed and mitigated claims and exposures as well as litigated claims.
  • Workers Compensation I - United Heartland, New Berlin WI.
08/1998 to 04/2000
Workers Compensation Claims Representative I United Heartland City, STATE,
  • Ensured claim payments adhered to administrative statutes.
  • Processed medical and indemnity claims accurately and timely to obtain timely file closure.
06/1996 to 08/1998
Workers Compensation Claims Technician United Heartland City, STATE,
  • Ensured accurate and timely payment of medical, temporary, permanent and expense benefits as well as associated filings with regulators.
  • Assisted Claims Representatives in daily claim handling.
Education
Expected in May 1995
Bachelor of Science: Finance Risk Management
University of Wisconsin - La Crosse, WI
GPA: GPA: 3.0

Finance Risk Management GPA: 3.0

Skills

medical billing, Quality, strategy, Trainer,

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Resume Overview

School Attended

  • University of Wisconsin

Job Titles Held:

  • Director, Corporate Claims, Enterprise Services
  • Director, Claims Strategy
  • Manager, Claims Operations
  • Manager, Claims Training and Quality
  • Workers Compensation Senior Claims Representative
  • Workers Compensation Claims Representative III
  • Workers Compensation Claims Representative II
  • Workers Compensation Claims Representative I
  • Workers Compensation Claims Technician

Degrees

  • Bachelor of Science

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