Quality Assurance Medical
Resume:
RONALD E. SCHAEFER
LOUISVILLE, KY 40223
SUMMARY OF QUALIFICATIONS AND EXPERIENCE:
Knowledge of Medical terminology.
Knowledge of MS programs - Word, Excel, Outlook.
Effectively work independently and multi-task in a fast paced team based environment.
Experience in program development and evaluation.
Lean Six Sigma Green Belt Certification
EDUCATION:
Grand Valley State University,
Allendale, MI
Bachelor of Science Degree in Political Science
Palm Beach State College,
Lake Worth, Florida
Associate Degree in Business
PROFESSIONAL EXPERIENCE:
01/12 – Present The Rawlings Company, LaGrange, KY
Insurance Analyst
* Review and analyze members' contracts to evaluate language related to exclusion and
recovery.
* Utilize proven methods of recovery to collect and/or negotiate settlements on behalf of
our health insurance clients in workers’ compensation cases, researching and
investigating potential workers’ compensation files via inquiries, questionnaires, and
reviewing member claim histories.
* Review medical claims paid by our clients (health insurers and health benefit plan
administrators) for re-coordination of benefits with workers compensation carriers or
intervening in litigated claims, ensure compliance with state and federal regulations as
well as individual plans.
03/03 - 11/10 Liberty Mutual Insurance, Kentwood, MI
03/08 - 11/10 Claims Specialist - Quality Assurance No Fault –PIP)
* Reviewed and analyzed files to determine compliance with claim handling standards.
* Listened to recorded phone calls to effectively determine if the call met quality
standards and summarize areas of development for feedback.
* Created and maintained spreadsheets and performance metric charts to track and report
individual and team performance.
* Presented data for weekly numbers meetings, monthly, quarterly and annual reports.
* Collaborated with management to recommend corrective action for follow up with
Ronald E. Schaefer
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individuals with persistent performance or quality concerns.
* Participated in calibration of quality assurance team and managers.
* Utilized quality improvement concepts including Lean Six Sigma.
03/03 - 03/08 Senior Claims Specialist I (No Fault -PIP)
* Confirmed coverage and conduct investigation to determine merits of claim and its
values.
* Maintained proper reserves
* Monitored continuing eligibility of Pip claimants.
* Received, coordinated, and paid appropriate Pip benefits.
* Secured appropriate Pip documents, i.e., medical reports, wage verifications, Pip
applications.
* Received and paid medical bills, wage loss benefits, survivor's economic benefits,
replacement service benefits and funeral expense benefits.
* Promptly disposed of claims by negotiations, settlement or denial.
* Managed, investigated, and settled personal injury claims.
* Worked with health insurance companies on coordinated benefits.
* Communicated with doctors and other medical providers to resolve claims.
* Negotiated claim settlements with attorneys.
11/99 - 11/02 Assurant Group, Grand Rapids, MI
Contact Center Operations Supervisor
* Direct supervision of a team of 15+ Customer
* Service/Inside Sales Associates: hiring, training, coaching, forecast/scheduling,
monitoring, evaluation and recognition.
* Conducted analyses and resolution of operational problems.
* Monitored, coordinated and adjusted resources for in-bound queues to achieve
maximum efficiency
* Listened to recorded phone calls to effectively determine if the call met quality
standards and summarize areas of development for feedback
* Maintained records related to work performance, attendance and expenditures.
* Participated in calibration of quality assurance team.
Contact this candidate