Post Job Free

Resume

Sign in

Claims Examiner Medical Records

Location:
East Northport, NY
Posted:
January 24, 2024

Contact this candidate

Resume:

Objective:

To utilize my extensive litigated claim handling experience and education to obtain a

rewarding position with opportunities for growth and advancement. Experience:

GEICO INSURANCE COMPANY JANUARY 1991-PRESENT

SENIOR LITIGATED CLAIMS EXAMINER 2000-PRESENT

Responsibilities involve handling all aspects of catastrophic claims from inception of loss to resolution of litigation including: Analysis of complex coverage issues; obtaining statements from witnesses; review and analysis of official and legal documents; determination of liability; investigation of complex medical records for determination of injury value; identification of fraudulent claims; summarization and referral of litigated cases to defense counsel; direction to defense counsel for handling of litigation including effecting early resolution to reduce costs; representation of Company at trials, arbitrations, and mediations; presentation of cases with settlement recommendations to all levels of management including Home Office; negotiation of catastrophic injury and fatalities as well as soft tissue cases.

PERFORMANCE ANALYST 2006-2009

Review and analysis of claim handling at all levels including management, Prepared reports and presented results to claims management including regional AVP. Developed criteria for review of defense counseling handling of litigated cases. Used Microsoft Excel for review and analysis of data for BI and settlement trends, case value, threshold denial review and numerous other studies. Participated in Market Conduct audits, supervisory audit training telephone monitoring, suit review and calibration of supervisor staff. CLAIMS EXAMINER/SUPERVISOR/TRAINER 1991-2000

Supervised Call Center and trained 6 classes of over 20 new hires per class. Supervised Payment Recovery Unit of 12 examiners and achieved highest recovery for 1997. Also handled claims examiner positions in all claims departments. Education:

Master of Science, SUNY Stony Brook, Harriman School of Management. Bachelor of Arts, Liberal Arts

Wendy Joyce

7 Cherry Lawn Lane

Northport NY 11768

Cell# 631-***-**** Home# 631-***-**** Email: ad216c@r.postjobfree.com



Contact this candidate