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Service Representative Medical Billing

Location:
Mesquite, TX
Posted:
July 27, 2020

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Resume:

KRISSY MENDOZA

Mesquite, TX 214-***-**** adev13@r.postjobfree.com

EXPERIENCED CANDIDATE FOR LITIGATION ADMINISTRATOR Offering Experience in the Administration of Litigation, Arbitration, and Mediation Matters

§ Highly skilled professional with expertise administering litigation in the Insurance industry, with a history of overseeing the work of defense attorneys representing client organizations in complex liability matters across all 50 states.

§ Expertise in leading the investigation of claims involving the review of medical records, photos, recorded statements, and other evidence to arrive at recommendations of settlement or litigation.

§ A demonstrated record of success delivering consistent results in a series of positions with Gallagher Bassett Services and the American Arbitration Association. AREAS OF EXPERTISE

Administering Litigation Matters

Conducting Claims Investigation

Scheduling Defense Attorneys

Developing Reports and Summaries

Developing Standards and Best Practices

Supporting Settlement Negotiations

Organizing Highly Complex Information

Experienced in Arbitration and Mediation Processes Building and Leading Strong Teams

Conducting Legal Analysis

Professional Experience

2014 to 2020 • GALLAGHER BASSETT SERVICES, INC.• Remote Gallagher Basset Services is a leading property/casualty third-party claims administrator with 100 offices worldwide, serving the needs of Fortune 1000 companies.

Lead Resolution Manager

Fulfilled a critical role managing, investigating, and evaluating a portfolio of auto and general liability claims, with a focus on accelerating the resolution of both litigated and non-litigated cases. Within each claim, arrived at determinations of coverage, liability, and damages for presentation to clients, the broker supervisor, and management, fully supported by legal analysis and findings of fact from investigations.

• Effectively managed broad-scope investigations involving interviews, surveillance, photo reviews, recorded statements, and medical record reviews, serving as the foundation for the development of reports for the General Counsel.

• Coordinated meetings between the Legal department and brokers to discuss claims and commit to decisions to settle or proceed to litigation based on the findings of each investigation.

• Directed litigation processes, coordinating the scheduling and management of defense attorneys representing clients in complex liability cases across multiple jurisdictions and in all 50 states. Contributes to settlement negotiations and other litigation activities, including attending mediations on behalf of clients. Successfully reduced litigation costs by 28%.

• Credited with establishing a claims management system from the ground up, providing a formal framework to process claims, handle medical billing, and audit documentation; developed reports on ongoing litigation and reviewed responses to subpoena requests.

• Orchestrated and executed a project to resolve a backlog of 375 Personal Injury Protection cases, directing a five-person team to review and categorize each claim, bringing all cases up to date within three months.

“Krissy has many strengths, including

her teamwork skills and very in-depth

knowledge of claims and the law. She

continually is willing to assist those

throughout our branch work through

their complex legal problems and

continues to manage our branch

litigation round table.”

Excerpt from Performance Review

Claims Management

Settlement Decisions

Legal Analysis

KRISSY MENDOZA

Mesquite, TX 214-***-**** adev13@r.postjobfree.com 2007 to 2014 • AMERICAN ARBITRATION ASSOCIATION • Dallas, TX The American Arbitration Association is a not-for-profit organization in the field of alternative dispute resolution, providing services to individuals and organizations who wish to resolve conflicts out of court, and one of several arbitration organizations that administers arbitration proceedings.

Manager of Alternative Dispute Resolution Services, Central Case Management Center Hired into a leadership role within the Construction and Real Estate Division, directing and mentoring a five-person team while managing a diverse portfolio of 350 ADR cases involving lawsuits relating to multi-million dollar construction projects. Maintained accountability for scheduling briefings, depositions, preliminary hearings, and evidentiary hearings.

• Maintained accountability for producing a broad and deep scope of work that included hearing notices, final orders, subpoenas, pleadings, interrogatories, motions, and awards.

• Served as the primary point of contact for the investigation of issues involving cases and clients, ensuring the overall quality of the client experience.

• Developed and strengthened relationships throughout the legal, business, and ADR communities to encourage the use of alternative dispute resolution.

• Facilitated the flow of key information relating to cases between the team, supervisors, and division-level stakeholders.

• Examined the specific circumstances of each case in order to identify and recommend a panel of mediators or arbitrators with the appropriate subject matter expertise. Addressed requests for the removal of arbitrators as required.

• Administered cases using the organization’s PRISM case management system, entering and updating information.

• Served as a resource for arbitrators with inquiries relating to procedural issues.

• Contributed to the success of training and education programs and conferences, as well as elections.

• Recognized for consistently lowering the costs of litigation through the recommendation of options that included mediation, arbitration, and direct settlement; over one 12-month period, successfully converted 35 disputes from arbitration to mediation, resulting in settlements that avoided substantial attorney’s fees. Early Career

Senior Customer Service Representative – Health Information Division, Portamedic Large Loss Property Claims Examiner, Safeco Insurance Company Personal Lines Auto/Bodily Injury Claims Adjuster, Kemper Auto and Home Claim Service Representative, Royal and Sun Alliance Education & Professional Licenses

PURDUE UNIVERSITY

Bachelor of Science Degree in Legal Studies

Coursework included Dispute Resolution, Tort Law, Trial and Courtroom Presentations, Legal Analysis & Writing Licensed Insurance Adjuster – Texas Department of Insurance Technical Proficiencies

PRISM, Westlaw, LexisNexis, ShareFile, Microsoft Office Language Skills

Fluent in English with Basic Proficiency in Spanish



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