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Medical Insurance

Location:
United States
Posted:
December 04, 2019

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Resume:

J. H. Grier

**** **** *****

Matthews, NC *****

Phone: 980-***-****

Email: adazzb@r.postjobfree.com

PROFESSIONAL SUMMARY

Licensed claims Examiner with extensive experience in the claims field.

Handled Claims for investigation for litigation and settlement.

Identify subrogation opportunities and proactively pursue recovery per Best Practices.

Settlement of injuries, property damage and medical payments claims, litigation, total loss evaluations and estimate review.

Sets appropriate reserves based on nature of incident, liability, venue, and injury/damage.

Attends mediations as an advocate on behalf of the insured in lawsuits involving insurance policies in force at the time of the loss.

Coordinate vendor referrals for additional investigation and/or litigation management.

Medically manage files.

EDUCATION

BA, Business Management, Accounting, Belmont Abbey College, Belmont, NC - 05/2016

MBA, Wake Forest University, Charlotte, NC – pursuing

PROPERTY AND CASUALTY LICENSES

North Carolina (exp)

South Carolina (exp)

Tennessee (exp)

JURISDICTIONS MANAGED

North Carolina

South Carolina

Pennsylvania

Virginia

Tennessee

Kentucky

Alabama

COMMUNITY INVOLVEMENT

Habitat for Humanity Home Building Project Gastonia, NC

Holy Angels Annual Bowling Night, Gastonia, NC

J. H. Gunn Community, Charlotte, NC

Gwynne Hill Festival Community, Charlotte, NC

SKILLS

Microsoft Office Suites (Word, Excel, PowerPoint, Outlook and Access),

Lotus Notes

Citrix

Riskmaster

Juris

PROFESSIONAL EXPERIENCE

Insurance Placement Solutions, Charlotte, NC

08/2019 - 10/2019 (contracted)

Communicate with all parties.

Identify subrogation opportunities and aggressively recover funds per Best Practices.

Forward the appropriate Excess Reports to carrier.

Obtain recorded statements to reduce litigated files.

Medically manage files to ensure accurate reserves.

Actively review files in inventory and identify ripe for settlement.

Develop a litigation plan with defense when appropriate.

Set appropriate reserves based on nature of incident, liability, venue, and injury/damage.

Attended mediations as an advocate on behalf of the insured in lawsuits involving insurance policies in force at the time of the loss.

Coordinates vendor referrals for additional investigation and/or litigation management.

Insurance Recruiting Specialist, Charlotte, NC 02/2012-02/2018

Proactively managed claims for investigation.

Identify subrogation opportunities and aggressively recover funds per Best Practices.

Collaborate with all parties involved in the claim.

Obtain recorded statements to reduce litigated files.

Medically manage files to ensure accurate reserves.

Reduce Old Claims (Aged Pendings).

Develop a litigation plan with defense when appropriate.

Settlement of injuries, property damage and medical payments claims, litigation, total loss evaluations and estimate review.

Set appropriate reserves based on nature of incident, liability, venue, and injury/damage.

Attended mediations as an advocate on behalf of the insured in lawsuits involving insurance policies in force at the time of the loss.

Coordinates vendor referrals for additional investigation and/or litigation management.

Travelers Insurance Company, Charlotte, NC 03/2008-12/2011

Claims Examiner/Lost Time Adjuster

Initial point of contact for insured and medical providers.

Investigate claims filed against client.

Complete a reserve analysis for the life of the claim.

Medically manage files.

Reduce Old Claims (Aged Pendings).

Identify subrogation opportunities and proactively pursue recovery per Best Practices.

Develop a litigation plan with defense when appropriate.

01/2006-02/2008

Notice of Loss Coordinator

Review all incoming claim files for coverage.

Locate and assign coverage if appropriate.

Assign them to various departments for handling.

Authorize the initial treatment when appropriate.

Consult employers on how to file a claim.

Complete additional duties at the request of superiors.

Review claim for jurisdiction.

Complete initial 3-point contact.

01/2005-12/2005

Medical Team Assistant

Assist Nurse Case Managers with the daily management of workers compensation files

Contact employees to ensure that all forms have been received, reviewed and returned.

Forward the appropriate medical form to the Industrial Commission.

Request medical records.

Translate medical records and update the medical file.



Contact this candidate