Hình đại diện của jpcarey23
@jpcarey23
Làm thành viên từ 21 tháng 1, 2015
0 Đề xuất

jpcarey23

Trực tuyến Ngoại tuyến
Executive with claims consulting firm who is available to review and work as an expert witness or review/audit claims files for best practices and give advice to employers, brokers, attorneys, medical providers or claimants to successfully navigate the California workers' compensation system. Also, has experience and expertise working with database administration & design, complex mathematics, algorithm development, project management, extensive writing experience and vast technical knowledge.
$50 USD/hr
0 nhận xét
0.0
  • N/ACông việc đã Hoàn thành
  • N/AĐúng ngân sách
  • N/AĐúng hạn
  • N/ATỉ lệ thuê lại

Portfolio Items

Các nhận xét gần đây

Không có nhận xét nào.

Trải nghiệm

Vice President, Claims

Jan 2012

• Management of all aspects of a claims department including client/broker relationships, carrier/TPA relationships and act as liaison for all complex issues. • Design an algorithm and Web application to identify high risk claims at claim's inception (Delayed Recovery/Early Intervention) for which a patent is now pending (US Patent Office Application No. 61735486). Train Nurse Case Managers to use this program and work with claims management teams at implementing the program. • Develop strategies & procedures for monitoring claims and advocating on behalf of policyholders. • Develop strong relationships with claims management at insurance carriers & third party administrators to ensure mutual cooperation and effective claims handling. • Assist with coordinating communication between carriers & administrators on cases involving multiple defendants to ensure all non-proprietary information is shared and to assist with developing joint strategies aimed at mitigating claims exposure. • Develop and implement database enhancements and reports to meet the needs of brokers, employers and attorneys. Administer database and create custom scripts, reports & queries. • Train staff on case law, WCAB procedures, new legislation, etc. and develop effective strategies to distribute to claims management, employer & broker partners for highly effective cost management and risk management strategies. • Maintain knowledge on all U.S. jurisdictions for workers' compensation, general liability and P&C exposure. • Assist all subordinates with developing effective strategies aimed at maintaining caseloads, diary management and report preparation. • Serve as expert in preparation for bad faith litigation. • Experienced in catastrophic, high exposure, high cost and complicated medical/legal claims. • Prepare and deliver training seminars to brokers & employers. • Participate and lead claims reviews. • Maintain expert knowledge on PD ratings using the 2005, 1997 and pre-97 PDRS as well as strategies for defending against Ogilvie & Almaraz/Guzman ratings. • Work with adjusters in all domestic U.S. jurisdictions with emphasis on California (both ADR & WCAB). • Assist brokers in managing high deductible policies, including reserve analysis & approval. • Train new analysts on all aspects of claims management. • Develop departmental policies & procedures, job descriptions, training programs, quality assurance process, personnel performance and internal audit protocols.

Senior Claims Examiner

Aug 2011 - Jan 2012 (5 months)

• Review and adjust claims to maintain compliance with the Labor Code. • Make decisions in regards to compensability of claims. • Pay benefits, settlements, and medical bills timely and accurately. • Analyze and review all claims while maintaining a diary to move each case towards finalization and closure. • Field phone calls from employers, employees, attorneys and medical providers. • Manage claims from inception to closure, ensuring that the claims are handled effectively, timely and pursuant to best claims practices. • Work as lead examiner for a highly active group of self-insured employers. • Provide training to other examiners and assistants as needed. • Experienced in high exposure, high cost, legally complex, and medically complex claims.

Senior Claims Analyst

Aug 2010 - Jul 2011 (11 months)

• Triage incoming claims to determine if further investigation is needed, if a given claim can be processed as first aid or needs to be escalated to third party administrator. • Provide expert support to all field offices with respect to workers’ compensation and disability management. • Manage claims across multiple jurisdictions and provide authority to adjusters for settlement, case managers, surveillance and concurrence on reserves & denials. • Continually analyze and evaluate all claims while maintaining an aggressive diary, moving each case to appropriate disposition. • Handle all contact with claimants, providers, attorneys, branches, safety managers and clients providing superior customer service • Utilize nurse case managers, attorneys, utilization review and other vendors to effectively achieve early intervention goals and ultimately finalize any given case.

Senior Claims Consultant

Feb 2009 - Feb 2010 (1 year)

• Handle claims from inception to resolution on an insured captive account, ensuring adherence to client service instructions, SAS-70 and best practices guidelines. • Render expert determinations of compensability on all disputed claims. • Furnish benefits, settlements and medical bills in adherence with established protocols as well as statutory and regulatory timeframes. • Continually analyze and evaluate all claims while maintaining an aggressive diary, moving each case to appropriate disposition, while simultaneously meeting strict quality standards. • Handle all contact with claimants, providers, attorneys, brokers, policyholders and the client providing superior customer service • Utilize nurse case managers, attorneys, utilization review and other vendors to effectively achieve early intervention goals and effectively manage my pending inventory • Train other examiners and claims assistants as necessary on relevant issues, such as lien negotiation, AMA ratings, penalties & interest, unit statistical reporting, EDI and reserves.

Senior Claims Representative

Apr 2007 - Dec 2008 (1 year)

• Manage claims from inception to closure, ensuring qualitative adherence to stringent client service instructions as well as established quality and best practices guidelines. • Make timely expert determinations of compensability on all disputed claims. • Pay all appropriate benefits, settlements, and medical bills timely and accurately in strict adherence with established protocols as well as statutory and regulatory timeframes. • Analyze and review all claims while maintaining a diary to move each case towards finalization and closure, while simultaneously meeting strict quality and audit standards. • Effectively field and handle all contact with claimants, providers, attorneys and the client • Negotiate settlements as necessary and work with UR achieving effective oversight on claims • Set and maintain a high standard of claims expertise to effectively manage all present and potential scenarios with respect to a given file

Senior Claims Examiner

Aug 2006 - Apr 2007 (8 months)

• Review and adjust claims to maintain compliance with the Labor Code. • Make decisions in regards to compensability of claims. • Pay benefits, settlements, and medical bills timely and accurately. • Analyze and review all claims while maintaining a diary to move each case towards finalization and closure. • Field phone calls from employers, employees, attorneys, and medical providers. • Manage claims from inception to closure, ensuring that the claims are handled effectively, timely and pursuant to best claims practices. • Work as lead examiner for a highly active group of self-insured employers. • Provide training to other examiners and assistants as needed. • Experienced in high exposure, high cost, legally complex, and medically complex claims

Workers' Compensation Claims Adjuster

May 2002 - Aug 2006 (4 years)

• Deliver compensation and medical treatment to injured workers in a timely fashion. • Make decisions in regards to acceptance, denial, and finalization of claims. • Ensure that benefits, settlements, and medical bills are paid timely and accurately. • Represent and protect employer’s interests, while delivering benefits on compensable cases. • Handle phone calls from employers, employees, attorneys, and medical providers. • Member of Fraud and Medical Committees; Webmaster for Social Committee. • Specially qualified to handle complex Permanent Disability claims, high exposure and high cost claims, and complex medical or legal claims. • Trained on pre-1997 and 1997-2004 PD schedules, and extensive AMA Guides training

Giáo dục

Bachelor of Arts

1995 - 1999 (4 years)

Bằng Cấp

Workers' Compensation Claims Professional (2013)

Insurance Educational Association

Experienced Adjuster Designation (2004)

California Department of Insurance

Certified experienced workers' compensation claims adjuster with CE hours current through 2016

Self-Insured Administrator (2004)

Division of Workers' Compensation, Self-Insured Programs

Các xuất bản

Import Tuner

Video game and consumer electronics columnist for import enthusiast magazine from 2001 through 2008.

Sport Compact Car

Editor and contributing writer for auto enthusiast magazine.

Honda Tuning

Editor and contributing writer for Honda enthusiast magazine 2001-2003.

Sport Compact Car

Editor and contributing writer for auto enthusiast magazine from 2001-2003.

Chứng nhận

  • US English Level 1
    95%
  • Numeracy 1
    88%

Xác minh

  • Đã kết nối với Facebook
  • Freelancer ưa thích
  • Thanh toán đã được xác minh
  • Đã xác nhận qua điện thoại
  • Đã xác thực danh tính
  • Email đã được xác minh

Xem những Freelancer tương tự