516-***-****

*** ******** *****

East Meadow, NY 11554

Michael A. Padronaggio, FLMI

Objective

Insurance Claims Professional with extensive experience seeks to utilize knowledge in a challenging position with a progressive financial company.

Experience

1993–2015 Guardian New York City & Bethlehem, PA

Sr. Insurance Fraud Investigator

Instantly recognizes fraudulent medical, dental, life, pharmaceutical, and disability claim scenarios resulting in savings of $2 million on one project.

Instituted collection procedures for those cases not referred to Law Department.

Recommendations sent to Claim Department for adjudication of medical, dental, life, death, pharmaceutical, and disability claims.

Point out weakness in procedures discovered during the course of an investigation to appropriate personnel.

Knowledgeable in all CPT codes, medical terminology, and reimbursement methodologies

Prepared documentation for grand jury hearings and attended them.

Acquired use of pivot tables and other financial instruments

Investigative use of all venues and internet sites.

Collects, researches, and validates bills and claims data against relevant guidelines.

Assists in preparation of statistical and financial analysis reports.

Requests medical records and additional documentation required for investigation.

Completes initial file set-up and tracks cases.

Processes and tracks all incoming reimbursement checks.

Manages fraud hotline calls.

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1992–1993 Guardian New York City

Supervisor, Group Life Claims

Recognized as bona-fide talent and promoted quickly.

Direct Staff of ten Life Claim Approvers.

Drafted procedure memos which were utilized in moving operations to Bethlehem, PA

Prepared monthly, quarterly and annual reports.

Review recommendations by subordinates and provide performance reviews.

1991-1992 Guardian New York City

Group Life Claim Approver

Responsible for the processing of Group Life and Waiver of Premium claims.

Coordinate information with Long Term Disability and at times Major Medical Departments. Refer matters to Law Department for legal opinions.

Proficiency in Microsoft Office and other applications.

1986-1991 Bankers Life & Casualty Co. of N.Y. Garden City, NY

Assistant Manager, Claim Department

Responsibility for the processing Individual Life and contestable death claims.

Utilize extensive knowledge of medical terminology accumulated in previous position not listed on this resume to process individual per cause medical plans.

Took over operation of Claim Department for one and one-half years in manager’s absence.

Educational representative for LOMA.

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Education

1976–1980 Brooklyn College Brooklyn, NY

B.A., Economics and Psychology.

Graduated Cum Laude.

Interests

Bike riding, gardening, family gatherings.

Prof. Organizations

Life Office Management Association.

National Health Care Antifraud Association.

Former VP of L.I. Claims Association.

Eastern Life and Eastern Claims Association

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