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Yyyyyy x. yyyyyy

- 1454 Major Oaks Rd Ÿ Pickering, ON L1X 2N5 ( (xxx-xxx-xxxx * abc@xyz.com

 

Claims Audit ▪ Compliance Management

Qualifications Profile

 

    Self-assured and results-driven solutions thinker & management professional in claims & compliance management, financial project management, contract management, and account management with more than 30 years in the consulting, financial services, and insurance sectors.

    Proven competence in and dedication to process efficiencies in business management with focus on claims adjudication and auditing, disability case management, mediation, and process improvements that enable the business to drive operational excellence, service quality, and cost advantages in highly competitive markets.

    Strong people management and interpersonal communication skills that inspire customer confidence, while fostering teamwork synergies with colleagues and subordinates in achieving shared objectives.

 

Professional Experience

 

Authen-Tech Security Consultant May 2016 | 2006 PRN

    Developed & executed WSIB Safety Procedures, Employee Handbook, RFP & RFQ for Government Tenders, Client Training presentation, Project Costing & Work Scheduling.

 

Desjardins Financial Trainer & Auditor Jan 2008 Oct 2015

    Conducted audits of Toronto, St. John s and Vancouver Disability Case Managers for claim trends, performance, and training needs assessment, while generating quarterly report to identify risks in claim management, privacy protection, compliance, and process improvements.

    Developed and executed training modules for Disability Case Management, eventually used as the Training Guide for all staff including Levis, and served as CLHIA representative

    Managed projects involving Subrogation, Teacher s True Up Adjustments, and development of Provincial Benefits and Claims Staff Reference Guides.

 

Sun Life of Canada Disability Management Specialist/Conversion Team/National Claims Dec 2001 Dec 2007

    Analyzed and evaluated LTD Claim Portfolio management on large and TLC accounts

    Actively engaged in 2 system conversion teams for the Clarica system acquisition/migration, balancing LTD claim transfers from to Sun Life s claim system and mapping of plan structure to move group plans to the Sun Claim System including groups with over 200 benefit plans

    Managed CPP and overpayments, liaising with cross functional teams as part of the National Claims Team.

 

Manulife Financial Quality Assurance Specialist (Claims Auditor) Sep 1997 Dec 2001

    Developed and implemented audit criteria, ensuring proper training of audit process and marking structure to staff

    Served as Lead Auditor for Waterloo and Toronto offices (150 staff) and backup for Montreal.

    Audited management for processes in handling disability and life waiver claims, identifying areas for risk mitigation.

    Coached and mentored staff in project management, as well as in handling complex claims and research.

 

Prudential Insurance Company of America Associate Manager 1991 1997 | 1985 - 1989

Maritime Life/John Hancock Claims Manager 1989 1991

Hay Management Association Consultant

 

Education & Credentials

 

    Certificate in Business Management, UNIVERSITY OF TORONTO Toronto, ON

Technical Skills

    Compliance Management: CLHIA(OSFI), PIPEDA, Charter, Employment, WSIB, Health & Safety and AODA

    Claims Management: Audit, Litigated & complex claims, benefit offsets, contestable and subrogated claims, legal discoveries, conflict mediation as Expert Witness on a contestable mortgage life claim in Quebec

    Project Management: CPP (ICD 10) fast track coding, development of Provincial Government Benefits Guide & Tax Reconciliation for T4A & T5 s

Professional Training & Certifications

    FLMI, ALHC and two parts of HIAA ADR Certificate, University of Windsor Product Manager Certification

    CEBS, parts 1, 2 & 4, Government Sponsored Benefits & Pensions Systemation, The Project Manager s Partner

    Train the Trainer Course IFOC Integrated Framework of Control (Risk Management)

    Accredited Insurance Compliance Professional (AICP)

    Regulated Immigration Consultant #R507808 (RCIC) (Resigned Dec 2016)

 

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