RONALD E. SCHAEFER

***** ****** **.

LOUISVILLE, KY 40223

502-***-****

SUMMARY OF QUALIFICATIONS AND EXPERIENCE:

Knowledge of Medical terminology.

Knowledge of MS programs - Word, Excel, Outlook.

Effectively work independently and multi-task in a fast paced team based environment.

Experience in program development and evaluation.

Lean Six Sigma Green Belt Certification

EDUCATION:

Grand Valley State University,

Allendale, MI

Bachelor of Science Degree in Political Science

Palm Beach State College,

Lake Worth, Florida

Associate Degree in Business

PROFESSIONAL EXPERIENCE:

01/12 – Present The Rawlings Company, LaGrange, KY

Insurance Analyst

* Review and analyze members' contracts to evaluate language related to exclusion and

recovery.

* Utilize proven methods of recovery to collect and/or negotiate settlements on behalf of

our health insurance clients in workers’ compensation cases, researching and

investigating potential workers’ compensation files via inquiries, questionnaires, and

reviewing member claim histories.

* Review medical claims paid by our clients (health insurers and health benefit plan

administrators) for re-coordination of benefits with workers compensation carriers or

intervening in litigated claims, ensure compliance with state and federal regulations as

well as individual plans.

03/03 - 11/10 Liberty Mutual Insurance, Kentwood, MI

03/08 - 11/10 Claims Specialist - Quality Assurance No Fault –PIP)

* Reviewed and analyzed files to determine compliance with claim handling standards.

* Listened to recorded phone calls to effectively determine if the call met quality

standards and summarize areas of development for feedback.

* Created and maintained spreadsheets and performance metric charts to track and report

individual and team performance.

* Presented data for weekly numbers meetings, monthly, quarterly and annual reports.

* Collaborated with management to recommend corrective action for follow up with

Ronald E. Schaefer

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individuals with persistent performance or quality concerns.

* Participated in calibration of quality assurance team and managers.

* Utilized quality improvement concepts including Lean Six Sigma.

03/03 - 03/08 Senior Claims Specialist I (No Fault -PIP)

* Confirmed coverage and conduct investigation to determine merits of claim and its

values.

* Maintained proper reserves

* Monitored continuing eligibility of Pip claimants.

* Received, coordinated, and paid appropriate Pip benefits.

* Secured appropriate Pip documents, i.e., medical reports, wage verifications, Pip

applications.

* Received and paid medical bills, wage loss benefits, survivor's economic benefits,

replacement service benefits and funeral expense benefits.

* Promptly disposed of claims by negotiations, settlement or denial.

* Managed, investigated, and settled personal injury claims.

* Worked with health insurance companies on coordinated benefits.

* Communicated with doctors and other medical providers to resolve claims.

* Negotiated claim settlements with attorneys.

11/99 - 11/02 Assurant Group, Grand Rapids, MI

Contact Center Operations Supervisor

* Direct supervision of a team of 15+ Customer

* Service/Inside Sales Associates: hiring, training, coaching, forecast/scheduling,

monitoring, evaluation and recognition.

* Conducted analyses and resolution of operational problems.

* Monitored, coordinated and adjusted resources for in-bound queues to achieve

maximum efficiency

* Listened to recorded phone calls to effectively determine if the call met quality

standards and summarize areas of development for feedback

* Maintained records related to work performance, attendance and expenditures.

* Participated in calibration of quality assurance team.

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