Project Management Quality Control

ALYSON WILSON

*** ******* *****, ******, ** ***** · 615-***-****

*************@*****.*** · linkedin.com/in/alyson-wilson-4995a559 Enthusiastic and ambitious individual seeking to obtain a position that continues to place a strong emphasis on the value of my communication skills, operations skills, and project management skills, all while continuing to develop and broaden my work expertise. EXPERIENCE

AUGUST 2023 – CURRENT

CENTRAL SUBROGATION MANAGER, TRISTAR RISK MANAGEMENT

• Handle a caseload of severe losses

• Oversee specialty claim handing

• Monthly reporting and statistics for claims department

• Research and develop policy and procedures.

• Create and implement new workflows and develop training materials

• Oversee project operations

• Oversee arbitration filings and maintain legal arguments and databases

• Develop and implement quality control processes

• Supervise a team of 30 adjusters

• Work with clients to achieve maximum recovery and to build back-end processing and reporting.

JANUARY 2014 – MAY 2023

CLAIMS OPERATIONS MANAGER/CLAIMS SUPERVISOR/CLAIMS AND SUBROGATION SPECIALST, AVANT SPECIALTY CLAIMS

• Monthly reporting and statistics for claims department

• Generate KPI’s, financial statements and reconciliation, identifying pro-rata claim adjustments

• Monthly bordereaux reconciliation

• Manage multiple bank accounts for producers and underwriters within the TPA authority

• Working to onboard new accounts for TPA claims management

• Working directly with vendors and reviewing vendor contracts

• Work directly with producers and underwriters to insure correct claims reporting

• Drafting policy and procedures, develop SOP and Best Practices

• Systems management and training, user testing and implementation

• IT Power User, responsible for liaising between claims and IT

• Direct supervision of claims assistants and claims representatives

• Indirect supervision of claims adjusters

• Claim review and authority request approvals

• Overseeing the intake and assignment of new losses

• Develop and oversee quality control processes

2

• Project management

• Handling first and third party heavy equipment/trucking claims on special accounts

• Witness statements and driver statements

• ISO/OFAC reporting

• Negotiating settlement

• Filing and answering arbitration

• Medical file review

• Reviewing files for litigation and overseeing the litigation process

• Liaising with attorneys and working to acquire and draft NDA’s FEBRUARY 2013 – NOVEMBER 2013

PARALEGAL, DHPM, PC

• Handled personal injury cases from sign up to settlement

• Completed intake appointments and handled all scheduling

• Drafted demands

• Drafted all legal complaints and answers

• Responded to interrogatories

• Requested medical records

• Drafted attorney correspondence and requests for documentation NOVEMBER 2010 – FEBRUARY 2013

PARALEGAL, KEMBERTON HEALTHCARE SERVICES

• Reviewed healthcare insurance denials and drafted appeals

• Reviewed workers’ compensation payment denials and drafted appeals Telephone conferences with clients, attorneys, doctor office and insurance adjusters EDUCATION

AUGUST 2001

BACHELOR OF SCIENCE, UNIVERSITY OF TENNESSEE AT CHATTANOOGA Double Major in Criminal Justice and Psychology

SKILLS

• Quality Control

• Operations Management

• Project Management

• Vendor Management

• Claims Management

• Analytic Problem Solving

• Claims Operating Systems

• Attorney Relationships

LICENSING AND CONTINUING EDUCATION

The Institutes – Medical Record Review

Adjuster License – DHS Florida and all reciprocating states

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