Case Manager Risk Management

John Scott Lawson

**** ******** *** **** 813-***-****

Plant City, Florida 33566 Mobile 813-***-****

*************@*****.***

OBJECTIVE

Leverage extensive management experience, technical expertise, and leadership skills to drive effective risk management strategies, mitigate organizational exposure, and optimize operational outcomes. EDUCATION

University of South Florida, Tampa, FL

Bachelor of Arts, Communications

December 1994

PROFESSIONAL EXPERIENCE

Florida Major Case Manager

Progressive Insurance – March 2010 to Present

Lead a team of 6 managers directly managing 42 SIU Investigators responsible for the training and development of 100+ claims professionals, focusing on identifying, investigating, and mitigating large-scale fraud and risk exposure.

Manage team performance, employee development, budget oversight, and strategic planning to ensure operational excellence.

Develop and implement fraud detection strategies, including training programs for field teams, resulting in improved claim referrals and risk identification.

Streamlined processes for case resolution, enhancing decision-making efficiency and reducing administrative redundancies.

Collaborate with litigation, legal, and underwriting teams to address complex fraud investigations and risk scenarios. Key Accomplishments:

Successfully transitioned a field-level team to a specialized major case unit, hiring and mentoring new specialists to handle complex fraud investigations.

Delivered measurable improvements in quality, customer service, and operational efficiency, achieving exceeds-level results in key performance metrics.

Conducted fraud awareness training that led to a significant increase in suspicious claim referrals. Responsibilities:

Personnel actions including hiring, performance evaluations, salary adjustments.

Coordinate training and development including performance certification for team members handling property and medical claims for North Florida.

The identification of patterns to determine the need for SIU involvement by utilizing data mined by analysts.

Develop strategies in handling large ring investigations and complex medical investigations.

The training and certification process surrounding examinations under oath by Florida SIU investigators.

Training of Florida claims personnel, approximately 225 employees in the identification of suspicious claims Lead a team of 6 managers overseeing 100+ claims professionals, focusing on identifying, investigating, and mitigating large-scale fraud and risk exposure.

Manage team performance, employee development, budget oversight, and strategic planning to ensure operational excellence.

Develop and implement fraud detection strategies, including training programs for field teams, resulting in improved claim referrals and risk identification.

Streamlined processes for case resolution, enhancing decision-making efficiency and reducing administrative redundancies.

Collaborate with litigation, legal, and underwriting teams to address complex fraud investigations and risk scenarios. Key Accomplishments:

Successfully transitioned a field-level team to a specialized major case unit, hiring and mentoring new specialists to handle complex fraud investigations.

Delivered measurable improvements in quality, customer service, and operational efficiency, achieving exceeds-level results in key performance metrics.

Conducted fraud awareness training that led to a significant increase in suspicious claim referrals. SIU Training and Development Project Leader

Progressive Insurance – March 2007 to March 2010

Designed and implemented company-wide training programs focused on fraud prevention, risk management, and claims investigation.

Partnered with data analytics teams to develop tools for identifying medical treatment patterns and fraud trends.

Led the development of high-impact training courses, including Examination Under Oath (EUO) protocols, to mitigate legal and financial risks.

Key Accomplishments:

Created a standardized fraud training program for managers, now mandatory across the organization.

Developed a commercial vehicle fraud investigation project, equipping teams with specialized tools to address high- risk claims.

Improved organizational risk assessment capabilities through the integration of advanced data analytics tools.

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This training process is handled by the Corporate Training team through the development of the curriculum and implementation in meetings conducted monthly.

Facilitate the participation of Progressive SIU in multi-company investigations including participation with law enforcement and other insurance carriers. Coordinate the utilization of company resources in concert with law enforcement after approval of appropriate operation plans. These operations include but are not limited to the use of vehicles in anti-theft stings and policies developed for undercover law enforcement personnel infiltrating staged accident rings.

Responsibilities:

Consults and collaborates with business leaders, Subject Matter Experts and others to assess how training can best impact the business process, build support for training program initiatives, and facilitate change management.

Manages relationships at all levels and across a broad range of interests, stakeholders and clients.

Facilitates teams to create strategies that meet the learning needs of diverse audiences.

Manages multiple training programs and Evaluates training program results (communicates trends, decisions, risks, and consequences).

Assimilates and analyzes meaningful data to identify root causes and determine impact.

Provides coaching, objectivity and discipline to group/team efforts (Management Development Specialists, Field Trainers, etc).

Designs, develops, manages and evaluates the curriculum for the SIU process.

Mentors the Subject Matter Experts, Managers, Trainers, and Process Leaders, providing feedback on performance gained by observation and evaluation.

Participates in the administration and facilitation of groups of classes. Progressive Insurance, Tampa, Florida

West Florida SIU Supervisor

Progressive Insurance – January 2004 to March 2007

Managed a team of 8 investigators specializing in fraud detection and risk mitigation for the West Florida region.

Oversaw investigations into staged accidents, theft rings, and large-scale fraud schemes, collaborating with law enforcement and industry partners.

Directed personnel actions, training, and certification processes to ensure team effectiveness in handling complex claims.

Key Accomplishments:

Led investigations that resulted in the denial of fraudulent claims worth over $1.25 million, including staged accident and theft rings.

Organized hands-on automobile arson training for law enforcement and insurance professionals, enhancing cross- industry collaboration.

Consistently achieved top performance metrics among regional teams.

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