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Legal Review Specialist/Paralegal/Investigator
Looking for a position as a Legal Review Specialist/Paralegal. I would like to utilize by abilities in obtaining claims overpayment recovery and subrogation recovery on third party accident claims, in addition to responding to complaints from State Regulators and Client/Policyholder base. It should be noted that I have strong verbal and written communication skills. Work with team members to develope new procedures that would greatly benefit the overall productivity of the corporation. I would also be interested in a Claims Administration/Supervisor position. I have managed a 12-14 member team with a responsibility of 2,000 team claim files. Past responsibility included communication with regulators and policyholders Implemented new procedures for the handling of claims adjudication for claims examiner and or examiner assistants during vacation time. Ability to effectively work with a team to build a strong work ethic.
Claims Examiner
About Me
Industry: |
Insurance |
|---|---|
Occupation: |
Claims Examiner |
Ideal Companies: |
Guardian Life Insurance Co, Genworth Long Term Care Insurance Co, Coordinated Health (Paralegal) |
Education level: |
Associate |
Will Relocate: |
No |
Location: |
Allentown, PA |
Work Experiences
1/2007 - /2009
Penn Treaty Network America
Individual Contributor
- Responsible for responding to policyholder and various government/regulatory complaints. In 2008 responded to 136 complaints successfully with 13 follow ups
which requested additional information to close complaint.
•
Researched claim/litigation files and developed time lines with appropriate plan of action for dispute resolution.
•
Identified/established subrogation liens and obtain recovery on third party accident claims in accordance with the policy guidelines and/or provisions. Maintained claim overpayment review and recovery in accordance with state regulations and policy guidelines and/or provisions. My total monetary recovery for 2008 was over
$50,000.00 with a total department recovery of $92,000.00 (this amount included my recovery).
•
Responsible for the reviewing of all Disability Claims and advise Third Party Administrator (TPA) as to payment or denial of these claims.
•
Maintained metric work logs for department work flow and production numbers.
•
Provided in house training on California Fair Claim Handling/Practice to all new claims examiners and policyholder service employees.
6/2001 - /2007
Penn Treaty Network America
Manager
- Claims Supervisor: August 2006 to November 2007 (Claims Department)
•
Managed a team of 12-14 employees with a total of 2,000 claims.
•
Implement coaching as required along with maintaining company protocol for
metrics score cards.
•
Reviewed and responded to claim appeals, claim complaints and Department of
Insurance inquires.
•
Responsible for end of year performance appraisals and pay raises for team
employees.
Lead Claims Examiner: September 2003 to August 2006 (Claims Department)
•
Assistant to Supervisor to review and respond to any/all personal issues and work
flow.
•
Reviewed and corrected employee claim files, employee denial letters along with
review of all free form letters.
Claims Examiner : September 2001 to September 2003 (Claims Department)
•
Reviewed all Home Health Care, Nursing Home and Disability/Hospital Claims for
available benefits according to the policy guidelines/criteria. Case load of 330 claim
files for review and adjudication.
•
Job duty included major decision making with the activity/non-activity of the file to
include restoration of benefit review, benefit eligibility, reimbursement of
benefits/non-reimbursement of benefits, denial review and medical necessity review.
•
Good verbal and written communication skills along with excellent organizational
skills.
Education
1997
Bachelor Degree
Cedar Crest College
- Business Administration with a Minor in Paralegal
1972
Certification Degree
Community Medical Center
- Medical Laboratory Technology
