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Vice President of Life & Health Claims
Profile# 11873
Education:  BS Degree.
Affiliations:  AHIP. MHP. HIA. LOMA studies.
Description:  Extensive experience, at executive-level, directing service operations.  Heavy expertise in project management, system conversions, process improvement and quality assurance.  Proven ability to coach, mentor and develop individuals.  Responsible for 10+ managers and 100+ employees delivering service to accident, health, critical illness and life policyholders.  Manage complex initiatives and strategic projects to improve customer experience, operational efficiency and key business controls.  Restructured management team.  Developed Claim Operations Manual to standardize procedures.  Improved claim accuracy, reduced processing time to less than 5 days.  Coordinated regulatory project to identify and issue unclaimed life insurance proceeds.  Initiated telephonic claim adjudication to simplify claim filing.  Established complaint and appeal process to address root cause of customer dissatisfaction.  Created new hire training and ongoing performance improvement for tenured staff.  Partnered with Underwriting, Actuarial, Sales and Compliance to develop new products and distribution channels resulting in increased revenue and policies in force.  Transitioned Medicare Supplement administration to new TPA without break in continuity of service.  Oversaw health claim operations servicing 280,000+ members.  Implemented quality assurance program to insure financial accuracy.  Created best-in-class claim administrative practices within $3M+ budget.  Lead telecommuter program for remote claim processors.  Experience in directing processing of 2M+ claims and handling 350,000+ calls annually.  Planned and implemented system conversion.  Attained financial accuracy of 98%+.  Processed over 90%+ of claims within 10 days.  Partnered with Sales and Marketing team to contribute to retention of 140,000+ plan members.

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