Experienced professional in the field of insurance benefits. Successful in regional and national account management; built a strong working relationship with employers, TPA's, brokerage firms, self-insured and County. Focused on maintaining high-performance standards and capitalizing on opportunities for ultimate growth. Seeking to leverage my background into a role with a progressive organization.
Provided supervision of claims adjusting and resolution activities; assisting Claims & Risk Financing Manager in planning, organizing, and directing the County Risk Management Department claims programs; acts as Claims & Risk Financing Manager in their absence. Further activities included day-to-day supervision of professional, paraprofessional, and clerical personnel, to ensure that the property/casualty claims, and worker's compensation claims programs are managed in accordance with public entity standards and best practices. Conferred with attorneys on legal issues affecting County exposure to risks. Managed and coordinated attorney representation on all litigated claims. Developed and maintained an information system for timely and accurate recording of claims, settlements, and other risk related costs. Assisted in preparation of operational and risk reports accompanied by management analysis and recommendations. Coordinated accurate and timely claims data to the Board of Trustees or to the Board of Supervisors for payment authority. Maintained communications with professional organizations in the risk management, and claims adjusting fields. Participated in the selection of staff, provided or coordinated staff training, coaching and implemented any necessary corrective action. Performed additional tasks as assigned by the Risk Manager.
Experienced in the development and execution of customer service. Gained consistent revenue growth within portfolio. Responsible for accounts receivable and client stewardship. Facilitated external account implementation. Gathered and modeled data to uncover trends and adjust strategies to capitalize on the latest information. Reduced process lags, within accounts. Demonstrated additional services at customer locations while pro-actively identify and solving complex problems that impact the client and the direction of the business involving potential risk. Streamlined operational efficiencies by developing customer service protocols and workflow standards within troubled accounts.
Analyze catastrophic/complex claims to determine client exposure. Face to face attendance involving customer claim reviews. Ability to understand new and unique exposure and coverage within multiple jurisdictions. Able to understand jurisdictional needs and changes and apply the same. Drafted statement of loss to summarize damages, payments and underlying policy coverage. Managed caseload of 120 active clients. Contacted injured parties and legal representatives to negotiate final settlements. Reduced loss ratios through fair and prompt processing of claims. Investigated any potentially fraudulent claims with a focus on thoroughness, quality and cost control.
Managed a team administrating FMLA and Disability benefits. Created specific workflow processes to maintain quality assurance standards. Created training manuals targeted at resolving the most difficult customer issues. Analyzed employee workloads to meet department needs. Fostered positive employee relationships through effective communication, development and coaching. Communicated and coordinated with multiple departments to achieve Total Performance initiatives. Interviewed, hired and trained over 100 new employees. Facilitated multiple pilot programs to develop new and improved strategies. Developed open and professional relationships with team members, enabling more effective issue resolution. Developed and implemented policies and procedures to improve retention rates and increase customer satisfaction. Resolved multiple litigated claims while being Medicare complaint. Lien resolution.
Job Titles Held: