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Yyyyyy x. yyyyyy

- 6357 Brando Loop Ÿ Xxxxxx, XXXXXX xxxxxx ( (xxx-xxx-xxxx *


Program Manager ▪ HR Administrator ▪ Account Management

Qualifixxxxxxtions Profile


    Self-assured, dynamic, and results-driven management professional with more than 16 years providing high-performance customer service in claim adjustments and adjudixxxxxxtion, investigative research management, xxxxxxse and program management, litigation support, settlement negotiation, mediation and arbitration, and compliance management in the insurance and benefit claims industries.

-    Proven dedixxxxxxtion to process efficiencies in legal and insurance xxxxxxse management and arbitration that provide in cost advantages in resolving conflicts even prior to a court-litigated resolution.

-    Detail-oriented, analytixxxxxxl and methodixxxxxxl with critixxxxxxl thinking to strategize win-win solutions that benefit both the company and claimant.

    Well-organized with multitasking and prioritization skills that optimize resources to achieve outstanding results.

    Decisive leadership with people management and business-aware social and interpersonal communixxxxxxtion skills that inspire confidence while forging teamwork synergies with colleagues across diverse ethnicities.


Key Expertise

Business Operations Management

    Strategic Planning & Execution

    Claims Operations Management

    Insurance Cover Adjustment

    Xxxxxxse Management

    Workers Compensation Administration

    Conflict Arbitration & Mediation

    Multiple Account Management

    Customer Service Management

    Fisxxxxxxl & Budget Management

    Process/Workflow Improvement

    Negotiations & Diplomacy

    Relationship Management (Clients, Stakeholders, & Suppliers)

    Risks Management

    Concurrent Project Management


    Regulatory Compliance (i.e., OSHA, WCXXXXXX, SSAE16, etc.)

    Staff Supervision & Training

    Records & Document Management


Professional Experience


Gallagher Bassett Investigative Service Regional Account Manager Aug 2016 Present

    Build sustainable business relationships with all clients and prospects within the assigned territory.

    Develop and execute account management strategies and engagement plans to drive business growth targets.

    Assist the sales team in preparing sales proposals and product presentations, taking part in marketing events, seminars, trade shows and association meetings to represent the company and build business networks

    Engage customers in identifying and resolving concerns that restore confidence and maintain repeat business.

    Exceeded sales goals for Sep, Oct, and Nov 2016.

Claims Practice Specialist Lead − Workers Compensation Apr 2014 Aug 2016

    Collaborated with assigned branches in Xxxxxx, working with key internal and external stakeholders such as brokers, claim examiners, defense counsels, and branch managers in achieving corporate goals.

    Built sustainable professional relationships with customers, coordinating claim reviews, resolving issues, and providing guidance consistent with corporate policies/procedures and best practices in accordance with applixxxxxxble statutory and regulatory requirements.

    Managed process improvement projects, communixxxxxxting project progress and issues to the executive committee,

    Oversaw litigation performance, coordinating with law firms in building up xxxxxxse documents and developing corrective action to address internal claim performance issues.

    Settled/closed 550 claims in 2014 and 1,345 in 2015.


LWP Claims Solutions Claims Operations Supervisor Jan 2013 Apr 2014

    Supervised 13 claims processor and staff assigned to the central service, overseeing state claims handled by assigned TPA (CO, AZ, TX, NV, NY, UT, AK, FL, IN, and WI), as well as all administrative functions for 53 bank accounts, providing replenishments, reconciliations, and daily check printing, while ensuring compliance with SSAE16.

    Evaluated and improved workflow processes involving vendor contract management, pricing, compliance, and RFP s.

    Established sustainable business relationships with clients, ensuring accurate invoicing between clients and vendors.

    Developed and executed action plans that resolved claim issues, reporting necessary information to excess xxxxxxrrier and risk bearer, while ensuring clients were well informed of all issues.

    Created claim reserves, collaborating with employers, employees, medixxxxxxl providers and external providers to maximize a cost-effective xxxxxxse resolution.

    Settled claims within authority, obtaining authority for larger claims in excess of authority, while ensuring that Social Security Disability (SSD), Medixxxxxxre, and CMS issues were addressed to the satisfaction of clients.

    Reduced backlog of pending medixxxxxxl payments by about 5,000, while training staff in complying with SSAE16.




Yyyyyy x. yyyyyy

- 6357 Brando Loop Ÿ Xxxxxx, XXXXXX xxxxxx ( (xxx-xxx-xxxx *


Professional Experience (continued)


Chartis Workers Compensation Hearing Representative Jan 2010 Jan 2013

    Provided legal and administrative support, analyzing complex legal and factual issues to determine company exposure and develop/execute defense strategies on behalf of clients in court-litigated issues.

    Aggressively advoxxxxxxted the position of the xxxxxxrrier/insured, collaborating with insured parties and 3 claims centers to deliver best results in pending litigation against insured/ xxxxxxrrier.

    Prepared settlement documents, pleadings, written discovery, depositions, motions, and legal briefs, representing the xxxxxxrrier in court and WXXXXXXB hearings, trials, mediations, arbitrations, and depositions.

    Built and maintained working relationships with court judges and staff, litigants, and counsels on both sides.

    Monitored all liens of record for Xxxxxx, documenting reduced legal exposures.

    Advoxxxxxxted a paperless office, successfully managing a paper reduction program for litigation assistants and clerks.


Travelers Return to Work Xxxxxxse Manager Jul 2006 Jan 2010

    Provided quality customer service, investigating, evaluating, negotiating, and resolving workers compensation claims at the most reasonable cost creating a win-win solution for the company and the claimant.

    Managed low-to-moderately complex xxxxxxses, exercising settlement authority based on several factors that included extent of coverage, legal and fiduciary liability, and xxxxxxusation/damages, while establishing and maintaining appropriate claim and expense reserves.

    Developed litigation plans, monitoring and control legal expenses, and achieving timely and optimal payout results.


Broadspire Claims Specialist III Sep 2004 Jul 2006

Allied Insurance Multi-line Senior Xxxxxxsualty Adjuster Jan 2003 Sep 2004

Zurich Insurance Special Handler Jan 2000 Jan 2003


Eduxxxxxxtion & Credentials


    M.S. in Human Resources, GOLDEN GATE UNIVERSITY (2009)

    B.A. in Communixxxxxxtions, Concentration: Intercultural & International Relations


    A.A. in Liberal Arts, AMERIXXXXXXN RIVER COLLEGE (2000)


Professional Training & Certifixxxxxxtions

    Worker s Compensation Claim s Administration (WCXXXXXX), Insurance Eduxxxxxxtional Association (IEA)

    Professional Certifixxxxxxte in Occupational Health and Safety (OSHT), OSHA Training Institute Region IX University of Xxxxxx, San Diego




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