Customer Service Insurance
Resume:
Phillip Bok, PhD. Risk Management and Insurance, PhD. Business Organizational Leadership, MIBA, MPA, MMC, MFP, B.S. ACCTG, AMA, AMC, ARM, APA, AFA, Ch E, CPCU, CIOP, CCIP, CPD, CWCP, CFSA, CIPA, CRCMP, CRCMP (Re) I, CRCMP - FELLOW CHR, CWM, CRA, CCP, LSSBB, FSIL FELLOW, RF, GAFM - FELLOW, CHRA,
Professional Profile
Bok and Associates, Inc. 2015 to Present
120 12th Street East
Tierra Verde, Florida 33715
**********@*****.***
President / Chief Risk Officer / Compliance Officer
Outside consultant responsible for identifying, analyzing, responding to, and monitoring risks and opportunities, within the internal and external PEO and Staffing environment facing the enterprise. Management selects a risk response strategy for specific risks identified and analyzed, which may include:
Implementation of State and Federal Safety Compliance Rules and Regulations
Conduct Monthly / Quarterly Safety Inspection and Evaluations
Loss Exposure / Claims Report Monitoring and Reporting to determine unprofitable clients and net loss cash flow
Avoidance: Analysis and determination of activities giving rise to risk and determine best technique that would apply
Reduction: Implement appropriate action plans to reduce the likelihood or impact related to the risk
Alternative Actions: Choosing and considering other feasible measures and action plans to minimize risk.
Share or Insure: Transferring or sharing a portion of the risk, to finance it or transfer a portion of the risk exposure
Accept: Due to a cost/benefit decision, decide whether to take risk or avoid Exposure
Strategic planning - Identifies external threats and competitive opportunities, along with strategic initiatives to address them
Marketing - Understand the target customer to ensure product/service alignment with customer requirements
Compliance & Ethics - Monitors compliance with code of conduct and directs fraud investigations with respects to claims, premiums, vendors and client misclassifications
Accounting / Financial compliance - Directs the Sarbanes-Oxley Section 302 and 404 assessment, which identifies financial reporting risks
Insurance - Ensure the proper insurance coverages, limits, indemnity agreements and waiver of subrogation for the organization
Operational Quality Assurance - Verifies operational output is within the company’s tolerances
Operations management - Ensures the business runs day-to-day and that related barriers are surfaced for resolution
Credit - Ensures any credit provided to customers is appropriate to their ability to pay – review receivable aging
Customer service - Ensures customer complaints are handled promptly and root causes of complaints are reported to operations for resolution
Internal audit - Evaluate the effectiveness of each of the above risk functions and recommends improvements
Fraud Investigation and Prosecution;
oClaims Fraud
oClaimant Fraud
oMedical Clinic Fraud
o Doctor Fraud
oIndependent Contractor Fraud
oBank Fraud / Money Laundering Fraud
oMisrepresentation Fraud
Policy Insurance Fraud
Classification Fraud
Premium Audit Fraud
Employee Coverage Fraud
Producer Fraud
TPA Handling Fraud
Accounting Fraud
Legal Counsel (Attorneys’) Fraud
Insurance Carrier Fraud
Insurance Billing Fraud
Federal & State Regulatory Fraud
Caruso Staffing 2005 to 2015
Senior Vice President / Chief Risk Officer, Underwriting, Audit, Claims, Quantitative Analysis & Insurance Operations
Responsible for direction and management of the risk management, insurance and non-insurance operations for Tri State Employment Services and affiliated companies. Primarily responsibilities include:
Direction and management of underwriting activities for all new and renewal business.
Development of strategic initiatives and tactical business plans to execute corporate strategy.
Proactive anticipation of future needs and serves as a catalyst in developing appropriate support.
Focus on achieving key cash flow / profitability, customer service and quality goals.
Ensure customer satisfaction, quality and financial results are met.
Coordinate activities of department with interrelated activities of inter-company departments and outside carrier departments:
Carrier Underwriting Policies & Protocols
Adherence to Company Underwriting Criteria
Provide Account Risk Analysis
Provide Renewal Information
Monitoring Master Policy and Individual Policies Experience Modifications
Maintain Master Policy and Individual Policies Loss History
Risk Management
Account Profitability
Account Loss Control Program
Recommendation of Account Program Improvements
Meetings with Carrier Loss Prevention Personnel for Technical Assistance and Account Compliance
Account Accident Investigation
Monitoring Accounts Experience Modification
Monitoring of Compliance with Federal and State Regulations (OSHA)
Claims
Review all Claims (Current and Prior Carriers)
Assist on Carrier Claims Reviews
Determine Claims Adequacy
Control Claims Costs
Follow-up on Claims Status
Follow-up on Subrogation Recovery Status
Claims Review Meetings Prior to Unit Statistical Reporting to Department of Insurance (Experience Modification Calculations)
Review and Follow-up on all Second Injury Fund Recoveries
Review Carrier Monthly Deductible Payments
Review Carrier Large Claims Settlements
Attend Large Claims Settlement Hearings
Investigate and Pursue all Claims Fraud Issues
Premium Auditing
Coordinate Final Premium Audit with Carrier
Establish Monthly Account Premium Accrual
Conduct Pre-Audits on Large Accounts prior to writing new business
Determine Proper Classification prior to writing account
Deal with all Regulatory Agencies on Insurance related issues
Investigate and Pursue all Premium Fraud Issues
Marketing
Assist Marketing Department on Problem Accounts
Assist Marketing Department on New Business Proposals and Presentation
Assist Tri-State Employment Services in Securing the Services of Additional Carriers for problem States and for Coverage Protection
Actuarial
Coordinate Actuarial Claims Analysis between Carrier Actuary and Tri-State’s Consulting Actuary
Coordinate Actuarial Claims Analysis in order to transfer current open claims to a TPA or another Carrier
Billing & Collections
Verify Accuracy of Loss and Premium Payments
Oversee timely payments of Premium and Losses to Insurance Carrier’s
Reinsurance
Investigate Self Insurance Program for Worker’s Compensation and Major Health Insurance Program
Legal
Assist Corporate Legal on all Insurance Related Matters
Accounting/Finance
Conduct a Monthly Analysis of LOC Claims Adequacy
Prepare and Manage Department Budget
Mergers & Acquisitions
Review Business Operations and Processes
Analyze Workers’ Compensation Claims, Classifications, Premiums, Overall Program & Coverage’s
Analyze Risk Management Department Operations and Impact on overall Operations
Wausau Insurance Companies / Member of Liberty Mutual Group 2001 to 2005
Commercial Markets – Accounting Manager
Responsible for managing the billing and receivables collections ($1.3 billion) and legal collections (attorney & bankruptcy - $40 million) functions for the Wausau Commercial Markets operations. Directs efforts to improve current and non-admitted receivables results. Develops and monitors receivables and credit analysts’ metrics to improve efficiencies. Implements budgetary and other systems for internal controls. Partners with markets to identify opportunities to improve cash flow, investment income, customer service and quality standards. Takes a leadership role in resolving the most complex customer service issues. Recruits and hires the best-qualified people. Develops and coaches’ management staff. Manages performance.
Superior National Insurance Group, Calabasas, CA 1994 to 2001
Vice President Premium Audit/Collections/Operations Analysis
Responsible for Operational and Financial reviews of both Home Office and Branch operations on a daily basis. Analysis conducted to determine the adequacy of existing controls verifying they are in compliance with accounting, organization and regulatory requirements. Provide oversight for nationwide premium audit operations, consisting of a $750 million Workers’ Compensation book of business, comprised of over 55,000 policies. Assisted Home Office MIS department in automating and steam lining premium audit and collection systems. Designated company expert witness for coverage, underwriting, premium audit, and collection issues. Worked extensively with in-house corporate council and external council on various corporate insurance issues. Collaborated with numerous District Attorneys’ offices on premium fraud cases, and successfully recovered over $6.5 million in restitution.
Education
University of South Florida, FL
Muma College of Business
PhD. Business Organizational Leadership
University of Florida
PhD. Risk Management and Insurance
Woodbury University, Burbank, CA
Bachelor of Science degree with a major in Accounting
Master Insurance Business Analysis (MIBA) Designation, Chartered Insurance Operations Professional Institute
Chartered Insurance Operations Professional (CIOP) Designation, Chartered Insurance Operations Professional Institute
Lean Sigma Six Black Belt (LSSBB) Designation, Chartered Insurance Operations Professional Institute
Fellow Society of Insurance Leaders (FSIL) Designation, Fellow of the Society of Insurance Leaders
Certified Workers’ Compensation Professional (CWCP) Designation, Michigan State University – The Workers Compensation Center - School of Labor & Industrial Relations
Chartered Property Casualty Underwriters, (CPCU) Designation, The American Institute for Property and Liability Underwriters, Inc.
Continued Professional Development, (CPD) Designation, The American Institute for Property and Liability Underwriters, Inc.
Certified Financial Services Auditor, (CFSA) Designation, National Association of Financial Service Auditors
Certified Insurance Premium Auditor, (CIPA), Designation, National Society of Insurance Premium Auditors
Associate in Premium Auditing, (APA) Designation, Insurance Institute of America
Associate in Risk Management, (ARM) Designation, Insurance Institute of America
Certified Risk and Compliance Management Professional, (CRCMP) Designation, International Association of Risk and Compliance Professional
Certified Risk and Compliance Management Professional in Insurance and Reinsurance, (CRCMP (Re) I), Designation, International Association of Risk and Compliance Professional
RF RIMS Fellow (RF) Designation, The Insurance Risk Management Society
Master Financial Planner (MFP) Designation, Global Academy of Finance, and Management
Master Management Consultant (MMC) Designation, Global Academy of Finance, and Management
Accredited Financial Analyst (AFA) Designation, Global Academy of Finance, and Management
Chartered Economist (Ch E) Designation, Global Academy of Finance, and Management
Certified Risk Analyst (CRA) Designation, Global Academy of Finance, and Management
Certified in Human Resources (CHR) Designation, Global Academy of Finance, and Management
Accredited Management Accountant (AMA), Global Academy of Finance, and Management
Chartered Certified Wealth Manager (CWM), Global Academy of Finance, and Management
Chartered Certified Insurance Professional (CCIP), Global Academy of Finance, and Management
Certified Compliance Professional (CCP), Global Academy of Finance, and Management
Master Professional Auditor (MPA), Global Academy of Finance, and Management
Certified Risk and Compliance Management Professional, (CRCMP - FELLOW) Designation, International Association of Risk and Compliance Professional
Professional Association
National Society of CPCU
CPCU Local Chapter (FL)
National Association of Financial Services Auditors
National Society of Insurance Premium Auditors
National Society of RIMS
NAPEO (National Association of Professional Employers Organization)
Society of Financial Service Professionals
The International Association of Risk and Compliance Professionals
Global Academy of Finance, and Management
Fellow Society of Insurance Leaders
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