Experience

The Peterman Group

• United States
• Insurance
• 1 - 100 Employee

• Claims Specialist

  • Nov 2015 - Present

  • Maintain all files associated with each claim and handle a caseload of up to 600+ files with $15M in reserves. • Prepare insurance documentation, including personal and commercial lines, and submit to carriers for handling • Coordinate with management to determine the validity of questionable claims • Explore available policy coverage for individual claims, assessed and verify claims, respond to customer inquiries • Review and evaluate contracts in order to generate binding certificates of insurance • Negotiate settlement on claims with insurance carriers Show less



Medical Audit and Review Solutions/Multiplan

• West Chester, PA

• Senior Claims Resolution Specialist

  • Oct 2014 - Nov 2015

  • Negotiated claims including retrospective and concurrent claims on behalf of payors in order to achieve the maximum discount. • Performed claim research and analysis of bill review to exceed the desired savings set by the payor. • Fostered and maintained provider relations to facilitate current and future negotiations • Exceeded all established departmental set performance metrics. • Instrumental in the training of staff on new operating system. • Negotiated claims including retrospective and concurrent claims on behalf of payors in order to achieve the maximum discount. • Performed claim research and analysis of bill review to exceed the desired savings set by the payor. • Fostered and maintained provider relations to facilitate current and future negotiations • Exceeded all established departmental set performance metrics. • Instrumental in the training of staff on new operating system.



Cotiviti

• United States
• IT Services and IT Consulting
• 700 & Above Employee

• Client Liaison

  • May 2012 - Sep 2014

  • Manage a portfolio of difficult to collect accounts totaling $40 million. • Directly responsible for collecting $21 million in overpayment revenue in first two quarters of 2014. • Designed and developed revenue reports to monitor and project production and collectability of accounts. • Negotiated settlements of accounts and effectively communicated with the client and providers to resolve overpayment issues. • Manage workload, staff performance and resolve and/or answer any staff related issues as needed. Show less



National Healthcare Payer Networks, LLC (NHPN)

• NHPN

• Compliance Manager

  • May 2008 - Jun 2012

  • Designed and developed the underpayment department from scratch. • Increased collections 40-60% annually from initial start-up. • Audited historical payment information to determine accuracy of reimbursements based on various provider contracts. • Generated revenue projections and tracked trends based on identified underpayments. • Developed and mentored a staff of underpayment auditors and collectors. • Negotiated settlements with insurance carriers and was liaison between the carriers and the client. Show less



New Penn Insurance Company

• Hopewell, NJ

• Sales Producer / Personal Lines Manager

  • Mar 2006 - May 2008

  • Top producer within the property and casualty division. • Created a direct marketing campaign for our newly created trucking and workers compensation insurance divisions. • Managed and mentored the personal lines administration personnel. • Assisted in the creation of the company website. • Top producer within the property and casualty division. • Created a direct marketing campaign for our newly created trucking and workers compensation insurance divisions. • Managed and mentored the personal lines administration personnel. • Assisted in the creation of the company website.



Aon

• United Kingdom
• Financial Services
• 700 & Above Employee

• Administration Manager / Sales Producer

  • May 2001 - Mar 2006

  • Managed and trained twenty plus individuals in various departmental capacities consisting of Enrollment, Underwriting, Fully Insured Business, Flexible Spending, Electronic Data Exchange and COBRA. • Authored a medical and dental claims processing manual along with educated the entire staff on its usage. • Played an integral part in the conversion of data and contracting information to our new processing system. • Second in total annual sales relating to homeowners and auto insurance policies. • Exceeded all sales quotas, inbound call volume and quality assurance expectations by 25-30%. • Monthly top salesman on a regular basis. • Trained and worked closely with all new sales associates. Show less