Customer Service Medical

Michael L. Rose ************@*****.***

**** ****** ******, ********, ** 48169 734-***-****

Career Direction Has Been Determined Based On Formal Education And Related

Professional Training, Diverse Hands-On Experience, And An In-Depth

Interest In...

. ALL ASPECTS OF THE INSURANCE CLAIMS INDUSTRY .

Some Areas Of Expertise Include, But Are Not Limited To...

- CLAIMS ADJUSTING - RISK MANAGEMENT -

- UNDERWRITING CONSULTING - LITIGATION MANAGEMENT -

- RESERVING & COST CONTROL -

- TRAINING - CUSTOMER SERVICE -

No Doubt, An Expert In My Field... An Effective Trainer, Motivator And Team

Builder... Possess Proven People Skills... Creative, Skilled And Very

Competent... An Excellent Negotiator And Communicator, Both Written And

Verbal...

DMA Claims Services, Battle Creek, Michigan.

The company is a Third Party Administrator (TPA), handling claims from

other insurance companies.

Litigation Specialist, 2009.

Managed, evaluated, investigated, negotiated, and resolved Michigan

litigated Personal Injury Protection (PIP) claims and litigated and un-

litigated Bodily Injury automobile accident claims. Monitored defense

counsel's activity, and ensured proper legal strategies were being

exercised. Also monitored defense counsel's legal fees to ensure they were

in line. Prepared necessary reports to management such as file reviews,

authority requests, coverage question reports, litigation plans, reports

for denials, etc. Ensured all bills associated with files were paid in a

timely manner, and billed for reasonable and necessary charges. Kept

management abreast of any significant concerns associated with the handling

of files.

. Implemented a file calendaring system so that every file was

thoroughly reviewed and worked approximately every thirty days.

Targeted problem files first, which were worked exclusively until they

could be brought up to date and any "hot issues" resolved. Prioritized

important concerns on a daily basis, by keeping track of potentially

explosive situations. Kept management in the loop of any problem files

that may have needed special attention. These actions resulted in my

files being consistently and professionally handled in a timely manner.

Due to the number of new files inherited, it was important to be able to

review, evaluate, analyze, and make recommendations expeditiously.

Tasks and mail work cues were always cleared out by the end of every

business day.

. To generate closings, was able to specifically target files that

could be brought to resolution within thirty days. This resulted in my

closing ratios every month being consistently at or near the top of our

office.

ProAssurance, Okemos, Michigan.

Ranked the number four writer of medical/dental malpractice insurance

within the U.S.

Claims Specialist, 2005 - 2009.

Facilitated investigation of reported medical malpractice claims against

doctors, and their staff, of all specialties, including dentists. This

involved determining applicable coverage and policy limits, identifying

coverage issues regarding exclusions and/or Reservation of Rights matters.

Met and interviewed the doctors during the Notice of Intent phase, obtained

and reviewed pertinent medical records, sent the case to experts for review

and discussion of opinions. Prepared the case for lawsuit handling,

including working closely with defense counsel. Prepared authority

requests for corporate committees and presented my cases to claim

management for settlement authority. Negotiated settlements with plaintiff

counsel when appropriate; monitored lawsuits for the company, keeping them

abreast of Discovery issues; worked with defense counsel in preparation for

trial, including preparing our doctors for their depositions. Performed

numerous other investigatory tasks associated with medical malpractice case

resolution. Maintained proper reserves at all times, monitored defense

counsel when litigation ensued, prepared timely reports, presented cases to

committees which included physicians, lawyers, underwriters, risk managers,

and other company personnel. Attended regional advisory board meetings

several times a year and presented my cases to doctors of all disciplines

around the State of Michigan. Attended trials, prepared reports at the

conclusion of every trial day, and distributed to key personnel.

. Maintained close and continuous contact with my doctors/dentists

throughout the claim process. Made myself available 24/7 in the event

of questions regarding their cases. Attended all hearings/meetings

including Case Evaluations, Facilitations, Mediations, Depositions,

Settlements Conferences, and Trials to put them at ease with the claim

process. Kept management abreast of any potential problems with our

physicians perhaps making poor witnesses on their own behalf, and

suggested witness preparation experts be utilized if appropriate. These

actions maintained good relationships with the doctors/dentists, which

resulted in the company never losing a trial during my tenure (15-0).

Michael L. Rose

Page Two Resume

State Farm Insurance Companies, Flint, Michigan.

Ranked #1 Property/Casualty insurer in the world.

Senior Claim Representative, 1989 - 2005.

Initially handled case load of over 200 property damage files including

negotiating settlements on automobile total losses, automobile thefts,

property damage claims, coverage questions, repair complaints, and various

other types of claims requiring diligent investigations and elaborate

reporting. Promoted to PIP handling with a caseload of over 250 complex

medical files. Ordered and reviewed medical records, reviewed medical

bills for reasonableness, paid wage loss and household services for injured

policyholders, managed return to work activities for injured policyholders

and claimants, arranged surveillance when necessary, scheduled independent

medical exams when deemed appropriate, and prepared files for court.

Maintained a strong working knowledge of medical terminology and treatment

codes from hospitals and physicians. Asked by management to proceed into

Bodily Injury Liability handling, due to my expertise shown in property

damage and PIP. Identified bodily injury liability exposure, interview

insured's, claimants and witnesses regarding facts and injuries sustained.

Investigated accidents and provided detailed written analysis of negligence

by all involved parties. Performed scene investigations including taking

photographs, sketching diagrams of accident scenes, and canvassing

neighborhoods for witnesses. Ordered and reviewed claimants' medical

records allowing for proper evaluation of claim value. Negotiated

settlements with claimants directly and/or attorneys when represented,

within my authority. Prepared detailed reports and present to management

when additional settlement authority is needed. Built knowledge of

insurance laws, motor vehicle codes, and case laws to support my findings.

Worked with defense counsel when litigation was instituted. Attended

depositions, settlement conferences, mediations, facilitations, and

ultimately trials. Managed my own State Farm sales office, with a staff of

two professionals as direct reports. Met sales monthly sales quotas and

service policyholders 24/7. Determined clients' insurance needs and

recommended appropriate products to meet their needs. Inspected new

businesses, completed necessary applications, and worked with underwriting

for policy issuance. Also, worked closely with claim department for

customers who sustained losses. Was a complex claim handler, only assigned

the most complicated cases. My caseload at those times was approximately

150 files, equally split between property damage and bodily injury

liability. Also involved in training new adjusters and acted as a resource

for my associates regarding claim issues.

. Worked long hours to increase knowledge of insurance business, asked

many questions and took some insurance classes. Have always a been a

quick study, so within a short amount of time I became quite adept at

handling PD claims. Was promoted into PIP claims, before finally being

elevated into handling BI claims. By the end of my sixteen-year run

with State Farm, I had done everything one could do within auto claims;

was also a State Farm sales agent for two years in Belleville, MI.

FORMAL EDUCATION

Kalamazoo College

Kalamazoo, Michigan, 1986

Bachelor of Arts

Major: English

Additional Professional Training

Associates in Claims (AIC) Designation . Two Parts of CPCU Designation

Completed

Numerous Claims Handling Instructional Courses, Seminars & Training

Programs

Licensed Independent Insurance Adjuster (Michigan & Louisiana)

Was Elected Captain of Football & Baseball Teams in Both High School &

College

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