Claims Consultant or Quality Assurance Consultant or Training Co
Claims Consultant, Quality Assurance Consultant, Training Consultant, Insurance Consultant with 20 years experience looking for a Direct Contributor position.
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Judith E. Boling, AIC, AIS 801 Cloverview Drive Crestview, FL 32536 850-398-6144 EDUCATION Southeastern College, Lakeland, Florida, BA Education Georgetown College, Georgetown, Kentucky, History/Political Science Rollins College, Orlando, Florida, Paralegal Studies EMPLOYMENT 10/00-12/09 Zurich North America Orlando, Florida; Dallas, Texas and Schaumburg, Illinois Team Manager: Manage a team of 8 workers' compensation claim professionals. Job accountabilities: 1. Participation in the development of the strategic plan for the claims organ ization 2. Applies claim and target market knowledge to identify how the organization can meet customer claim service needs 3. Manages claim center resources to deliver customized claim service that is specific to customer needs 4. Contributes to profitability by effectively implementing "Claims Best Prac tices: to manage loss payments and expenses 5. Drives automation of key processes to realize cost, time, accuracy and/or q uality improvements 6. Works co-operatively across claim centers and offices to ensure co-ordinati on of services and sharing of best practices. Business accountabilities: 1. Manage relationships with key customers within area of responsibility 2. Develop or enable the development of new and expanding business opportuniti es 3. As needs arise, use network of contacts with specialized expertise 4. Identify opportunities and risks associated with changes in the external en vironment, looking forward 1-2 years 5. Design, recommend and implement changes to processes and systems 6. Develop and implement annual budget for area of responsibility 7. Set and execute operational objectives and plan aligned to the strategy of the business unit 8. Ensure appropriate documentation, implementation and communication of proced ures and operating standards are completed for area of responsibility 9. Regularly monitors and evaluates activities to identify potential risks and issues of non-compliance 10. Lead risk assessment for area of responsibility and escalate potential issue s to senior management Performance accountabilities: 1. Model behaviors that demonstrate commitment to corporate values 2. Complete the performance management cycle with staff, providing coaching an d feedback for improved performance 3. Meet objective of the business unit's people management plan 4. Ensure all staff have established and are implementing development plans 5. Take action to manage own personal development and encourage others to do t he same Quality Assurance Claims Auditor Job accountabilities: 1. Review sample of files to measure claim handling compliance and economic oppo rtunities using a define methodology 2. Make effective presentations to field office staff providing insight into the strengths and areas of non-compliance that exist within the office 3. Responsible for composing and reviewing technical reports which provide a det ailed summary of the reviewed office results and are distributed to senior manag ement 4. Identify claim handling and/or claim process skill gaps and provide field and
home office management with feedback and/or improvement recommendations 5. Perform validation of audits completed by field office management staff and r eports identified improvement opportunities 6. Co-operatively participates on projects which require input from multiple em ployees working as a team 7. Participates in claim technical training seminars as needed 8. Participates as part of a joint Field-Home Office team to plan, develop and implement a redesigned audit program 9. Review a random sample of files with Special Handling Instructions to captur e compliance requirements Business Accountabilities: 1. Provide expert solutions for key customer(s) 2. Enhance business through consulting with key customers 3. Ensures the successful completion of projects by maintaining continuing dialo gue with business unit sponsors during implementation of major projects 4. Deliver high quality, technical solutions 5. Diagnose and develop recommendations to solve unique business unit and custom er problems 6. Lead complex technical or long-term (over 6 months) business projects to impl ement new or changed systems, programs or products 7. Investigate, recommend and implement leading edge technical solutions when th ey meet customer need Performance Accountabilities: 1. Model behaviors that demonstrate commitment to corporate values 2. Provide input into performance management discussions of project team members 3. Coach and provide technical advice and counsel within and outside operating u nit 4. Provide guidance and support for team members 5. Take action to manage own personal development and encourage others to do the same Quality Assurance Baseline Project: Participated in the Workers' Compensation Q A Baseline file review project. Developed recommendations based on the file rev iew and participated on the Implementation Phase of the WC QA Baseline recommend ations. Project Manager and Facilitator for the Construction Defect and Staff L egal QA Baseline group through file review, baseline discussion, development of recommendations, presentation to senior management and implementation of recomme ndations. Co-Facilitated the Mass Lit/Pollution /Healthcare QA Baseline Project during the initial baseline discussion. Litigation Specialist: handled complex, litigated workers' compensation claims f or large profile designated accounts; completed case summary presentations to ac counts; served as a resource for employers and frequently made visits to insur ed locations to assist in training local staff. 5/00-9/00 Hartford Specialty Risk Services Lake Mary, Florida Claims Consultant. Handled complex litigated workers'compensation claims for la rge profile accounts. Made on-site visits to the insured location, prepared det ailed status reports and worked closely with risk managers and brokers. 10/99-4/00 FCCI Insurance Group Atlanta, Georgia Southeast Branch Coordinator. Claims supervision of multiple jurisdictions incl uding GA, AL & TN. Actively involved in business development and marketing. Ma de frequent presentations to agents, employers, brokers and industry professiona ls. 12/95-10/99 Humana Workers' Compensation Services Longwood, Florida and Nashville, Tennessee Claims Supervisor. Directed a team of 8 adjusters handling workers' compensati on claims in AL, GA, KS, KY, MO, MS, NC, SC, TN and VA; also supervised a suppor
t staff of 3. Assisted adjusters with reinsurance reports and reports on catast rophic claims. Actively involved in marketing for business and often made presen tations to agents, brokers, risk manager, prospective employers and active insur ed accounts. 3/95-12/95 Maguire, Voorhis & Wells, P.A. Orlando, Florida Paralegal. Review/summarize medical records, prepared case law summaries, prepar e motions and pleadings, legal research, and prepared pre-trial stipulations. 3/93-3/95 RISCORP of Florida Sarasota and Maitland, Florida Group Leader/Senior Claims Representative. Handled litigated and non-litigated workers' compensation claims in the Florida jurisdiction. Supervised office in managers' absence. 2/90-2/93 Crawford & Company Orlando, Florida Claims Adjuster. Received initial training in the handling of workers' compensa tion claims. OTHER Chairperson of HWCS Vendor Committee, Instructor in HWCS Managed Care Trai ning program, Supervisor Mentor, Member of WCCP, Member of Mid-South WC Associat ion, Member of Nashville Claims Association, Member of Atlanta Claims Associatio n, Florida All-Lines licensed adjuster, Florida Board Certified Workers' Compens ation adjuster, Teacher of the Year 1988-1989, Director of Public Relations for Sigma Kappa Sorority 1981-1983. Completed educational requirements for AIC and A IS designations. Currently pursuing ARM designation. REFERENCES Available upon request
home office management with feedback and/or improvement recommendations 5. Perform validation of audits completed by field office management staff and r eports identified improvement opportunities 6. Co-operatively participates on projects which require input from multiple em ployees working as a team 7. Participates in claim technical training seminars as needed 8. Participates as part of a joint Field-Home Office team to plan, develop and implement a redesigned audit program 9. Review a random sample of files with Special Handling Instructions to captur e compliance requirements Business Accountabilities: 1. Provide expert solutions for key customer(s) 2. Enhance business through consulting with key customers 3. Ensures the successful completion of projects by maintaining continuing dialo gue with business unit sponsors during implementation of major projects 4. Deliver high quality, technical solutions 5. Diagnose and develop recommendations to solve unique business unit and custom er problems 6. Lead complex technical or long-term (over 6 months) business projects to impl ement new or changed systems, programs or products 7. Investigate, recommend and implement leading edge technical solutions when th ey meet customer need Performance Accountabilities: 1. Model behaviors that demonstrate commitment to corporate values 2. Provide input into performance management discussions of project team members 3. Coach and provide technical advice and counsel within and outside operating u nit 4. Provide guidance and support for team members 5. Take action to manage own personal development and encourage others to do the same Quality Assurance Baseline Project: Participated in the Workers' Compensation Q A Baseline file review project. Developed recommendations based on the file rev iew and participated on the Implementation Phase of the WC QA Baseline recommend ations. Project Manager and Facilitator for the Construction Defect and Staff L egal QA Baseline group through file review, baseline discussion, development of recommendations, presentation to senior management and implementation of recomme ndations. Co-Facilitated the Mass Lit/Pollution /Healthcare QA Baseline Project during the initial baseline discussion. Litigation Specialist: handled complex, litigated workers' compensation claims f or large profile designated accounts; completed case summary presentations to ac counts; served as a resource for employers and frequently made visits to insur ed locations to assist in training local staff. 5/00-9/00 Hartford Specialty Risk Services Lake Mary, Florida Claims Consultant. Handled complex litigated workers'compensation claims for la rge profile accounts. Made on-site visits to the insured location, prepared det ailed status reports and worked closely with risk managers and brokers. 10/99-4/00 FCCI Insurance Group Atlanta, Georgia Southeast Branch Coordinator. Claims supervision of multiple jurisdictions incl uding GA, AL & TN. Actively involved in business development and marketing. Ma de frequent presentations to agents, employers, brokers and industry professiona ls. 12/95-10/99 Humana Workers' Compensation Services Longwood, Florida and Nashville, Tennessee Claims Supervisor. Directed a team of 8 adjusters handling workers' compensati on claims in AL, GA, KS, KY, MO, MS, NC, SC, TN and VA; also supervised a suppor
t staff of 3. Assisted adjusters with reinsurance reports and reports on catast rophic claims. Actively involved in marketing for business and often made presen tations to agents, brokers, risk manager, prospective employers and active insur ed accounts. 3/95-12/95 Maguire, Voorhis & Wells, P.A. Orlando, Florida Paralegal. Review/summarize medical records, prepared case law summaries, prepar e motions and pleadings, legal research, and prepared pre-trial stipulations. 3/93-3/95 RISCORP of Florida Sarasota and Maitland, Florida Group Leader/Senior Claims Representative. Handled litigated and non-litigated workers' compensation claims in the Florida jurisdiction. Supervised office in managers' absence. 2/90-2/93 Crawford & Company Orlando, Florida Claims Adjuster. Received initial training in the handling of workers' compensa tion claims. OTHER Chairperson of HWCS Vendor Committee, Instructor in HWCS Managed Care Trai ning program, Supervisor Mentor, Member of WCCP, Member of Mid-South WC Associat ion, Member of Nashville Claims Association, Member of Atlanta Claims Associatio n, Florida All-Lines licensed adjuster, Florida Board Certified Workers' Compens ation adjuster, Teacher of the Year 1988-1989, Director of Public Relations for Sigma Kappa Sorority 1981-1983. Completed educational requirements for AIC and A IS designations. Currently pursuing ARM designation. REFERENCES Available upon request
