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Customer Service Insurance

Location:
St. Petersburg, Florida, 33715, United States
Posted:
August 26, 2018

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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

ac6tf4@r.postjobfree.com

1-917-***-****

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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