Experience

Security Health Plan

• Insurance
• 200 - 300 Employee

• Underwriting Manager

  • Dec 2016 - Present

  Marshfield, WI

• Underwriter

  • Dec 2005 - Present

  Marshfield, WI Perform risk appraisal and evaluate overall claim experience for large prospect groups. Ensure compliance of prospects with the corporate underwriting standards. This past year I have worked on a Small Group Renewal Audit that has encompassed reviewing small groups as they are renewing coverage. The results of this project have established new underwriting policies and company standards. This project process required coordination of information and comminucations with staff from Sales… Show more Perform risk appraisal and evaluate overall claim experience for large prospect groups. Ensure compliance of prospects with the corporate underwriting standards. This past year I have worked on a Small Group Renewal Audit that has encompassed reviewing small groups as they are renewing coverage. The results of this project have established new underwriting policies and company standards. This project process required coordination of information and comminucations with staff from Sales, Legal, IS and Marketing departments.



Quartz Health Solutions

• United States
• Hospitals and Health Care
• 400 - 500 Employee

• Senior Underwriter

  • Apr 1998 - Dec 2005

  Perform risk appraisal and evaluate overall claim experience to ensure conformance with the corporate underwriting standards. Perform accurate and timely evaluations for rating of prospects and renewals. Responsible for effective Underwriting procedures to ensure success, profitability and retention of accounts. Monitor rating and benefit changes to ensure timely, accurate and profitable implementation of necessary amendments to contracts. Consult with Sales, Marketing, Enrollment, Legal… Show more Perform risk appraisal and evaluate overall claim experience to ensure conformance with the corporate underwriting standards. Perform accurate and timely evaluations for rating of prospects and renewals. Responsible for effective Underwriting procedures to ensure success, profitability and retention of accounts. Monitor rating and benefit changes to ensure timely, accurate and profitable implementation of necessary amendments to contracts. Consult with Sales, Marketing, Enrollment, Legal, Actuarial and Operations personnel, to assess plan changes and ensure premium income adequately reflects the group’s experience and to ensure contracts comply with legal statutes and corporate underwriting guidelines. Project team member for several projects involving the Underwriting department premium rating.

• Benefit Plan Specialist and Claims Reimbursement Analyst

  • Jun 1989 - Apr 1998

  Review and analyze outpatient claims for benefit coverage, processing consistency, and identify trends in billing practices. Respond to complex internal and external inquiries regarding benefit coverage and payment issues. Participate in committees which analyze and review plan coverage, analyze feasibility of making benefit or administrative changes. Review and maintain fee schedules. Research claims coding for payment determination through the aid of computer software package. Audit… Show more Review and analyze outpatient claims for benefit coverage, processing consistency, and identify trends in billing practices. Respond to complex internal and external inquiries regarding benefit coverage and payment issues. Participate in committees which analyze and review plan coverage, analyze feasibility of making benefit or administrative changes. Review and maintain fee schedules. Research claims coding for payment determination through the aid of computer software package. Audit internal and external claims processes and practices.



WPS Health Insurance

• United States
• Insurance
• 700 & Above Employee

• Internal Auditor

  • Jun 1985 - Jul 1989

  Health Claims Auditor for CHAMPUS/CHAMPVA.



Wisconsin Physicians Service

• Claims and Operations Auditor

  • Jul 1985 - Jun 1989

  Entered as a provider coder. Was advanced to claims Examiner in the Medical Review Department where I examined all types of claims for medical necessity, specializing in skilled nursing. Worked with fee profile to determine allowable amounts on CPT-IV codes. Responded to written and telephone inquiries on fee schedules. Assigned to special projects, such as codebook updates, working with Joint Health Benefit providers, and revising fee schedules. In February of 1988 was advanced to Claims… Show more Entered as a provider coder. Was advanced to claims Examiner in the Medical Review Department where I examined all types of claims for medical necessity, specializing in skilled nursing. Worked with fee profile to determine allowable amounts on CPT-IV codes. Responded to written and telephone inquiries on fee schedules. Assigned to special projects, such as codebook updates, working with Joint Health Benefit providers, and revising fee schedules. In February of 1988 was advanced to Claims and Operation Auditor within the Internal Audit Department. Responsibilities include audit and analyze the insurance claim process. Provide monthly and quarterly reports to management. Show less