Management Insurance

Toni Hamilton, AIC, AINS, CPHRM, SSGB

**** ***** **** ***** ******, OH 43537 *******@***.*** 419-861-

**** **** 419-***-**** mobile

Qualifications for Executive-Level Claims Management

Analytical, results-focused professional with 20+ years of experience in

claims mitigation, mediation, negotiation, and litigation-providing all

aspects of case management, from coverage analysis through state and

federal reporting. Diverse background in claims management spans multiple

lines, including professional liability, auto liability, product liability,

general/commercial liability, municipal/environmental liability, and

property. Applies a proactive team approach that encourages

accountability, consistent performance, and compliance to minimize risk and

ensure consistent product quality. Expertise encompasses strategic

planning, startup operations, policy/procedure development, and process

improvement.

Key Highlights

. Manages claims through a wholly owned captive insurer for ProMedica

Health System, an integrated healthcare system comprised of 67 major

corporations and joint ventures with over 15,000 employees, 2,700

physicians, 11 hospitals, and 200 facilities.

. Participates on numerous committees, including the Risk Council, Best

Practices Council, Business Unit/Corporate Leadership Committee, Root

Cause Analysis/Quality Committee, and Corporate Claims Committee.

. Delivers substantial annual reductions in both indemnity and expense

payments by instituting an internal claims management program focused on

proactive cost containment and control of claim outcomes.

. Defines claim handling protocols in accordance with best practices and

lead a claims team to execute claim audits that recognize sound reserve

practices, claims management protocols, and consistent application of best

claim practices for nine consecutive years.

. Establishes claims protocols for mandatory reporting of claim file

activity; litigation management, including reporting requirements; case

summaries; internal audit guidelines; and implementation of best

practices.

. Trained and mentored junior claims personnel on coverage analysis,

statutory requirements, and best practices.

. Investigated and settled claims of insolvent insurers for those qualified

for protection(s) pursuant to the Ohio and West Virginia Insurance

Guarantee Associations as defined by their respective state laws and order

of liquidation.

. Tripled staff size to handle the largest malpractice insurer insolvency

in the history of the state of Ohio.

Career Progression

Claims Consultant, National focus, Toledo, Ohio

2011 to present

Claims consulting including external claims auditing, case

analysis/evaluation, process/improvement management, staff development,

litigation supervision, mediation and temporary position placement.

Current client:: HCR Manor Care

Corporate Claims Manager, ProMedica Health System, Toledo, OH 2001 to

Present

Developed, implemented, and manages a claims program to handle claims

internally as covered through the wholly owned captive, including

professional liability, general liability, auto, employer liability,

director/officer, and property coverage. Investigates, mediates,

negotiates, and litigates pending claims. Consistently achieves excellent

audit reviews from both internal and external auditors. Plays a role in

leadership, quality, risk management, and staff development; encourages

other claims professionals to pursue industry designations and stay current

in both legal and medical issues.

Claims Supervisor, Ohio Insurance Guaranty Association, Columbus, OH

1997 to 2001

Supervised claim staff, managed litigation, performed internal audits,

maintained quality controls/best practices, and defined and enforced

adequate reserves/reserving practices. Trained staff on coverage analysis

and statutory requirements pursuant to ORC 3955 and best practices.

Insurance Consultant, Self-Employed, Columbus, OH 1994 to 1997

Investigated and negotiated automobile, general liability, and property

claims, and managed related litigation for clients (Ohio, Texas, and West

Virginia Insurance Guaranty Associations; CNA Insurance; Milwaukee

Insurance Co.; Bradford Adjusting). Independently audited professional

liability, product, workers' compensation, auto, and general liability

claims.

Ohio Insurance Guaranty Association, Claims Examiner, Columbus,

OH 1988 to 1994

Investigated, and negotiated automobile, property, general liability,

products liability, professional liability, E&O,

D& O, environmental and other liability claims and manage related

litigation. Job included complex coverage analysis and application of

statutory laws governing the Ohio Insurance Guaranty Association.

Physicians Insurance Company of Ohio (PICO), Pickerington,

Ohio 1985 to 1988

Supervised auto liability, property, general liability, and professional

liability claims and related litigation; including mediation, subrogation,

inter-company arbitration, subrogation and litigation management.

Credentials

Villanova University - Six Sigma - In Progress - Masters Certification

Green Belt to be completed February of 2011.

Chartered Property Casualty Underwriter (CPCU) - In Progress - CPCU 551,

CPCU 552, CPCU 553 completed

Certified Professional Healthcare Risk Manager (CPHRM) - ASHRM/AHA

Associate in Claims (AIC)

Associate in General Insurance (AINS)

Belford University - Bachelor of Science in Law

University of Toledo - General Studies

Owens Technical College - Accounting

Affiliations

. Northwest Ohio Risk & Insurance Management Society (Board Member)

. Risk & Insurance Management Society- RIMS

. Toledo Claims Association (Executive Council/ Past President)

. American Society for Healthcare Risk Management - ASHRM

. Ohio Society for Healthcare Risk Management - OSHRM

. American Hospital Association - AHA

. Ohio Hospital Association - OHA

. Council on Litigation Management.

. Toledo Chamber of Commerce

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