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Claims Manager Medical Malpractice

Location:
Burke, VA
Posted:
April 26, 2020

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Resume:

Margie Creighton

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

Burke, Virginia 22015

571-***-****

adcy1t@r.postjobfree.com

Claims professional with over 25 years of experience in the insurance industry.

Broad base of knowledge and expertise in hiring, training and managing large claims staffs.

Management of a multitude of complex medical professional liability insurance claims for companies insuring physicians, hospitals and allied health care providers.

Assessing and restructuring of claim departments for greater operational efficiency and cost savings.

Exudes a high level of energy & enthusiasm helping to successfully motivate an organization’s claim staff.

Excellent management and communication skills

Education:

University of South Carolina, Masters in Education (Rehabilitation Counseling) University of Tennessee, Bachelor of Science, magna cum laude, Phi Kappa Phi Stephens College, Associate of Arts, Phi Theta Kappa, Curator Scholar Award, Baccalaureate speaker Professional Certifications & Courses:

Paralegal Certificate, University of North Carolina at Charlotte Medical Coding CPT and ICD-10 11/2019 (to complete final course work 2/2020 followed by national exam for CPC) ASHRM CPHRM Prep Course 10/2011

Certified Professional Healthcare Risk Management (CPHRM) certification from 2013-2016 Enterprise Risk Management Workshop -ASHRM Academy- 4/2015 American Academy of Neurosurgery Managing Coding & Reimbursement Challenges in Neurosurgery-4/2015 Michigan State University’s Certified Worker’s Comp Workshop 6/2011 Certified Workers Comp Professional (CWCP) from 2011-2014 Professional License: Multi-line Property & Casualty Adjuster License in Texas Professional Memberships: ASHRM

Professional Experience: Epiq, Washington DC: Document Reviewer, Contract Work- June, 2018. Review used Relativity. Excalibur Legal Staffing, Washington, DC: Senior Claims Specialist and Reviewer for Office of Risk Management, DC Government 6/2016-1/2017 (Contract to hire in 9/2016) Responsible for reviewing a backlog of Worker’s Compensation cases for evaluation, recommendation and disposition. Placed in charge of special projects including preparing pay charts, mentoring a new claim rep, closing old cases. Reviewed and analyzed dept. loss runs, statistics, manpower and made recommendations to restructure the dept. to normalize workloads which were instituted by Dir of Claims. (Departure due to fracture/surgery of right dominant wrist followed by OT) Jan 2016-May 2016 Temporary Relocation to NC for family reasons. Medmarc Insurance, A ProAssurance Co, Chantilly, VA: Claims Specialist: 3/2013-5/2015 Transitioned from this temp position with Insurance Overload Services to permanent on 5/29/2013 and was responsible for attorney malpractice cases and Bar disciplinary matters. Handling case from inception to conclusion interviewing insured attorney, obtaining expert witnesses, recommending reserve changes and resolutions to superiors. Novant Health System, Winston Salem, N.C.: Claim Manager: 6/6/2011-11/16/2012 Transitioned from Claim and Risk Management Consultant on 3/5/2012 from Vertical Claims Management (VCM), a TPA who placed me in the consulting assignment on 6/6/2011. Novant is a tri state Health System in NC, SC and VA with 13 facilities, many outpatient imaging centers, and a physician RRG, New Star.

Accomplishments:

Instrumental in implementing processes and procedural changes for the claim department and for facilitating interactions with the hospital and physician risk managers.

Served as a resource person to all of the risk managers; involved in loss run revisions; trained 2 staff members to handle GL cases at hospitals/physician offices; helped write an educational plan to take to the staff at the facilities to teach them regarding visitor falls & occurrences in hospitals and to improve communication among departments.

Successfully managed a large number of suits, claims, incidents in NC, SC, and VA for hospitals & physicians from inception to conclusion attending many Mediations. (Resigned due to extensive travel and unmanageable work load due to short staffing).

Professional Risk Management Services, Inc., Arlington, VA: Claim Examiner: 4/08-6/10

(PRMS was the managing agent for The American Psychiatric Association’s sponsored insurance program)

Managed litigation files in 11 states including interviewing insured physicians, locating expert witnesses, reviewing and evaluating medical reports and assessing injuries and damage potential.

Prepared pre-trial reports, presenting reports to committees, attending mediations, negotiating settlements and monitoring trials while preparing daily trial reports. Union County Public Schools, Charlotte, North Carolina: 10/06-2/08

Worked as a Tutor and After School Director for 21st Century program

Fulltime Teacher Assistant in the 4th & 5th Grades at East Elementary School, a Title I school. CNA Insurance, Health Pro, Charlotte, NC: Excess Liability Claim Consultant: 4/03-12/05

Claim Reviewer and Consultant for accounts where CNA provided medical professional liability excess and reinsurance coverage to hospitals/ medical schools/ and physician captives. Responsible for all active accounts written in the Chicago Underwriting Department of CNA to include on-site claim audits, preparation of audit reports and loss run analysis reports to underwriting staff and claim directors.

Foster and maintain communication with Risk Managers and General Counsel regarding high damage cases and management of self-insured retention programs.

St. Paul Insurance, Charlotte, NC: Claim Specialist: 3/02-3/03

Recruited and Appointed to a three-member regional Catastrophe Team handling serious injury and high-exposure medical malpractice cases for NC hospitals. Investigated, mediated and successfully resolved over 110 remaining cases for the company. Joined with a one-year commitment to help with “run-off” med mal business. Feb 2001-Feb 2002 Part time work through Randstad staffing & Substitute teaching with NEISD San Antonio Jan 2000-Feb 2001 Unexpected Major Surgery followed by Full Medical Leave Order through Feb, 2001 Aug 1999-Dec 1999 Sabbatical with three year old adopted son. Medical Underwriters of California- Medical Insurance Exchange (MIEC), Oakland, CA: Assistant Claims Manager: 1/89-7/99 (10.7 years)

Accomplishments & Responsibilities:

Second person in charge of 35-member claim department with 2000 open claims/suits in 7 states. In charge of the department in Claim Manager’s absence with policy-limits authority, full decision-making authority & responsibility.

Direct daily responsibility for all claims/suit files with reserves up to $100,000. Reviewed all other serious injury-high exposure cases at set up, on diary, and with Manager at time of settlement authority.

Supervised all blood bank and AIDs litigation

In 1996 increased involvement in all facets of supervision of the clerical staff including interviewing, hiring, disciplinary action, implementing group training and serving as a troubleshooter for all staff.

Along with the Claims Manager, assessed claim department personnel needs, territorial needs, interviewed, and hired claim field staff.

Charged with all on-going training of the field staff.

Designed a new reporting format and identified responsibilities for claim reps and supervisors to enable claim reps to investigate, negotiate and handle to a conclusion 90-day notice claim files previously assigned to defense counsel resulting in savings in defense cost and a motivated claim field staff.

Solely responsible for creating, directing and implementing training program for new claim reps.

Conducted yearly on-site reviews of sub-office in Hawaii; met with claim personnel, assessed workloads, duties and implemented changes to improve function of the office.

Invited to conduct four independent claim department on-site reviews/audits for two out-of- state companies/ Joint Underwriting Associations. Designed an audit checklist, trained staff member to assist. Prepared a comprehensive written report of results.

In 1994 appointed to Claims Section Committee of the Physicians Insurers Association of America (PIAA). Assisted in planning and personally participated in the programs at the annual PIAA meetings. American Physicians Insurance Exchange, Austin, TX: 2/84-1/89 (5 years) Vice President – Claims (6/86-1/89 in position)

Headed department of nineteen with over 1400 open claims and suits in Texas and Arkansas.

Restructured the claims department, establishing middle management positions, territories and levels of authority.

Hired new investigators and established aggressive training program for staff.

Responsible for all reserve changes, reviewing all claims on a periodic basis, ensuring that a department diary system was in place, reviewing and auditing attorney bills for effective cost control, and meeting with and maintaining good communication with reinsurance carriers. Settlement authority of $100,000.

Established new procedures in the Dallas sub-office for better work efficiency with routine visits to Dallas.

Familiar with activities of Underwriting Claims Committee of APIE Board and participated as requested.

Prepared and presented Claims Activity reports quarterly at APIE Board of Directors meetings.

Assisted President in search and interview process for Director of Education-Loss Control. Assisted in implementing a new Loss Control program, which included speaking at evening monthly meetings with physicians throughout Texas and Arkansas.

Established new guidelines for law firms meeting with key partners in the firm; recommended and interviewed additional law firms to defend cases.

Department experienced tremendous growth almost doubling in size during tenure as VP necessitating department restructuring, aggressive training and good checks and balances systems.

First female Vice President at APIE.

Claim Supervisor (2/86-5/86 in position)

In charge of department in the absence of the VP, supervised 4 claim investigators, including review of files for reserve changes, investigation and disposition of cases. Responsible for assigning all files in the department and continued to handle caseload of 100 high-exposure cases in South Texas area. Senior Claim Investigator (2/84-2/86 in position)

Handled all aspects of investigating, evaluating and negotiating medical malpractice cases in South Texas. Conference Organization and Speaking:

PIAA Claims Section Committee Planning Member and Participant for Claims Section Prof Meetings and Annual Conferences from 11/94-6/99

Claims Section Professional Seminar Newport Beach, CA: Speaker, 11/88

University of Arkansas, Little Rock, College of Medicine Faculty, Guest Speaker on Claims & Risk Management, 6/88



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