Experience

NuQuest is Now IMPAXX

• United States
• Insurance
• 1 - 100 Employee

• Administration Service Specialist

  • Sep 2011 - Present

  Responsibilities in performing contractual and daily operational activities in the administration of Medicare set aside and medical custodial accounts of post settlement workers compensation and liability claims. Work with attorneys, insurance companies and settlement brokers on post-settlement requirements for account activation to include: providing quotes for service, drafting contracts, securing releases and banking forms. Participate in conference calls with attorneys and their clients to review administration service. Performs accounting functions on new accounts to include bank exports and invoicing. Case management of active accounts administration - medical bill review, investigate physician requests for treatment, prescriptions and durable medical equipment for causal relationship to the covered injuries and Medicare guideline requirements. Show less



Work Comp Strategic Solutions

• 1 - 100 Employee

• Workers Compensation Claim Manager

  • Mar 2010 - Jul 2011

  Responsible to supervise Third Party Claim administrator on all claim functions of clients' workers' compensation claims to include compensability decisions, subrogation, reserving, case management strategies, state regulation compliance, litigation management and service agreement compliance. Conduct claim file reviews and medical bill audits of contracted Third Party Claim Administrator. Provide case updates and customer service to clients. Schedule independent medical exams and put together medical documentation for the physician. Show less



Sunoco Inc.

• Greater Philadelphia Area

• Workers' Compensation Claim Manager/Insurance Specialist

  • May 2003 - Jul 2008

  Responsible to manage third party claim administrator on all claim functions to include compensability decisions, subrogation, reserving, case management strategies, state regulation compliance, litigation management and service agreement compliance. Coordinate/negotiate settlements, attend mediations and hearings. Conduct claim file reviews and medical bill audits of contracted Third Party Claim Administrator. Facilitate quarterly insurance meetings with internal customers to discuss financial impact and case strategies on all open claims. Participate in health, environmental and safety training for employees. Gather information for insurance renewal for the domestic casualty program for workers' compensation, auto and general liability. Maintain company automobile fleet records and distribute insurance cards. Review, approve and process self insurance renewals and assessments. Show less



ESIS, Inc.

• United States
• Insurance
• 700 & Above Employee

• Workers' Compensation Claim Supervisor

  • Oct 1991 - May 2003

  Managed a team of six claim professionals dedicated to large special risk and self insured customers. Job responsibilities: to review claim adjusters' files to ensure the compliance of claim best practices, timely state form filing, adherence to customers' service agreements and the identification of subrogation and fraud. Managed a team of six claim professionals dedicated to large special risk and self insured customers. Job responsibilities: to review claim adjusters' files to ensure the compliance of claim best practices, timely state form filing, adherence to customers' service agreements and the identification of subrogation and fraud.