Senior Claims Manager & Appeals Specialist

MICHAEL E. GIPSON

(Contact information available upon request)

PROFESSIONAL SUMMARY

Claims and insurance professional with over 25 years of experience handling life, disability, workers’ compensation, and voluntary benefit claims. Demonstrated expertise in claims evaluation, appeals analysis, and compliance with policy and regulatory guidelines. Recognized for strong analytical abilities, attention to detail, and consistent delivery of high-quality claim decisions.

CORE COMPETENCIES

Claims Management (STD, LTD, Life, Voluntary Benefits)

Appeals & Consumer Advocacy

Team Leadership & Performance Management

Regulatory & Compliance Knowledge

Process Improvement (Six Sigma Yellow Belt)

PROFESSIONAL EXPERIENCE

Cigna/NewYork Life — Dallas, TX

Claims Manager / Senior Claims Manager / Consumer Advocate 2004 – Present

Serve as lead claims contact for multiple national accounts, ensuring accurate and timely claims resolution.

Manage Short-Term Disability, Long-Term Disability, Life, Voluntary Benefits, and waiver of premium claims.

Partner closely with account managers and internal experts to support effective claims administration.

Co-managed a team of 19 claims professionals, driving service excellence, meeting performance metrics, and fostering a positive work environment.

Resolve complex appeals across all lines of business through detailed analysis, effective resource utilization, and collaboration with claimants, attorneys, and internal partners.

Selected for the Dallas Leadership Development Program (2008–2009).

Completed Six Sigma Yellow Belt training.

Resource Life Insurance — Dallas, TX

Senior Claims Analyst 1998 – 2004

Investigated and adjudicated Short-Term and Long-Term Disability claims in accordance with policy provisions.

Determined company liability through detailed review and interpretation of policy guidelines.

Conducted interviews and coordinated communication with claimants, physicians, employers, attorneys, and other stakeholders.

Represented management when senior leadership was unavailable and supported overall claims department operations.

Hartford Insurance Company — Dallas, TX

Medical Bill Examiner III 1992 – 1998

Audited Texas workers’ compensation claims by interpreting CPT/ICD-9 codes and applying TWCC medical fee guidelines.

Applied multi-state workers’ compensation guidelines to ensure compliance and accuracy.

Assisted with team leadership responsibilities and employee development initiatives.

Served on the Continuous Improvement Team to help develop office policies and procedures.

EDUCATION & CERTIFICATIONS

Skyline Career Development Center — Honors Graduate, 1986

Navarro College — Business Administration, 1986–1988

Dean’s List

National Honor Society

Phi Sigma Omega

Phi Theta Kappa

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