Michelle Smith-Puente, MBA

***** **** **** ****, ******, TX 76244

817-***-****

acyx4j@r.postjobfree.com

SUMMARY OF QUALIFICATIONS

A results driven management professional with 17 years of insurance and

healthcare industry claims experience. A visionary that is highly skilled

in employee development and team building across all functional groups in

the department. A leader that encourages and promotes an environment of

teamwork to exceed key performance metrics in a high stressed, fast paced

claim environment. An originator that improves performance by adopting

processes to increase claims production; which will drive down claim cycle

time. A leader dedicated to increasing quality scores by providing

continued training to the department. A key player that will improve

customer satisfaction by fostering a culture focused on exceeding customer

expectations.

PROFESSIONAL MANAGEMENT EXPERIENCE

Arkansas Claims/Risk Management Inc. (CMI), Carrollton, TX

09/2016- current

Supervisor II General Liability: Wal-Mart- Displacement of department to

Arkansas announced

Provide leadership to a team of adjusters that investigate and resolve GL

claims on behalf of Wal-Mart

* Exceeding key performance measurements set by the company

including: 15 day decision date goal;

30/60/90 day closure goals; and quality investigations

* November 2016- two members of my team recognized for having the

highest closures in the department

* Able to improve the overall morale of the team in a short period

of time by demonstrating positive leadership

Fiberlink Integrations, Fort Worth, TX

03/2015- 08/2016

Business Consultant/ Partner

Leveraged my MBA by participating in a new business venture

* Managed the start-up process for the company

* Oversaw the business administration facet of the company

Cook Children's Health Plan, Fort Worth, TX

01/2013- 03/2015

Claims Manager

Provided operational leadership to the Managed Care Organization (MCO)

* Managed the claims administration of the State of Texas Medicaid

programs: Star, CHIP, and CHIP Perinatal programs for the nine counties

the MCO serviced; paying $156 million dollars annually

* Supervised a claims staff of 15 employees that covered the complete

claims cycle: mail room; data entry; claims examination; appeals and

grievances

* Achieved continued compliance with the state of Texas and Health and

Human Services (HHSC) Uniform Managed Care Manual

* Exceeded key performance metrics outlined by HHSC: improved the

department quality score to 99.5%; improved the claims call center

abandonment rate to 5%

* Drove down claims department adjudication cycle time by two days

* Ensured all required reporting was completed accurately and submitted

timely to the State

* Member of the Fraud, Waste and Abuse committee- cross functional

committee (Compliance, Legal, Medical Director, Claims) that reviewed

claim files for potential fraud, waste, and abuse

Transamerica Long Term Care, Bedford, TX

09/2007- 01/2013

Claims Manager- LTCP Designated

Provided operational leadership to the Long Term Care insurance Claims

eligibility department

* Managed the Claims Intake department which consisted of: two Supervisors

and 22 professional level exempt employees (RN's; LVN's; LMSW's;

experienced claim professionals) that adjudicated LTC and AD&D claims for

the company

* Streamlined the operations of the department and transformed it to a high

production and high customer satisfaction functional area that

consistently met service level agreements with claim payments at $260

million dollars annually

* Mentored and coached employees to continuously produce results that

exceeded company goals

Transamerica Long Term Care, continued

* Indispensable part of the management team that developed and implemented

new methodologies, procedures, and processes to ensure continued success

with exceeding SLA's

* Safeguarded compliance standards by ensuring the department complied with

laws and regulations for the 35 states the company serviced

* Chaired the Claims Review committee: a cross functional committee that

included Claims Leadership, Legal, Medical Director, and Compliance. Met

biweekly to discuss complex and/or contested claims

* Nailed down a continued training schedule for staff on policy language,

new policy forms, and clinical/medical training

* Cultivated positive relationships with key vendors in the industry

* Maintained good relationships with high producing agents in the market

place by being accessible to them for claim related training

* Actively participated in all process improvement initiatives that related

to the Claims department

CUNA Mutual, Fort Worth, TX

07/2006-0 07/2006- 07/2007

Claims Manager

Managed the claims department for the Collateral Protection line of

insurance

* Administered the new collateral protection claims operation in Fort Worth

* Managed the performance of 10 licensed adjusters

* Extensively involved in process improvements and process implementation

for the department

* Supervised the department workflow that spanned claims adjudication in

over 25 states

Boy Scouts of America, Irving, TX

02/2006- 07/2006

Casualty Claims Supervisor

Supervised the claims process for the organization

* Managed the claims case load for the United States and Puerto Rico

* Supervised remote adjusters and monitored the progress of each claim

through regular communications

* Attended mediations and trials as a representative of the organization

* Assisted with the litigation and settlement strategy of cases by working

with attorneys

* Member of the Risk Management Advisory Council

PROFESSIONAL EXPERIENCE

Merastar, Chattanooga, TN 05/2004- 12/2005

Case Manager (telecommuter)

Selected by Merastar to stay on as a direct hire to mitigate claims

for them in TX and CO

Claims Analyst, Esurance as a TPA for Merastar, Addison, TX

Recruited to participate in a new business venture as a TPA between

Esurance and Merastar to mitigate claims in TX and CO

Allstate, Irving, TX 09/1998- 05/2004

Case Manager

Mitigated every aspect of the claim: the liability investigation;

negotiation of bodily injury release and settlements; property damage

settlements including total loss/salvage; and litigated case settlements

SKILLS

Skills: negotiation; conflict resolution; team building and leadership

development; communication; strategic planning; quality improvement;

inventory control; budget management; employee development; policy and

procedure development; contract interpretation; customer service.

Technical: Microsoft Office suites; AS400 based applications; various

proprietary claims applications; Kronos; Lawson; ADP call center

software; Internet; office equipment

EDUCATION

M.B.A., University of Dallas, Member of Sigma Iota Epsilon honors

fraternity

B.S., Texas State University

Texas Property and Casualty Adjuster's license

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