Alexandra Sutter Email & Phone Number

Cleveland, Ohio, United States

• Create and maintain client relationships with a book of business up to $100,000 in premium including working in conjunction with Account Managers with larger books of business up to $2,000,000 in premium. • Respond to client requests for policy changes, billing inquiries and verification of coverage.• Secure documentation needed to be retained by the agency including signed applications, replacement cost estimates, rejection of coverage and confirmation of orders. • Reconcile accounting discrepancies. • Secure Lost Policy Releases and follows through to policy cancellation. • Assist in the development of strong business relationships with appropriate insurance carrier personnel. • Ensure accuracy of account information for both new and renewal policies, endorsements, and audits for accuracy in rating, coverage, signatures, and enters these transactions to generate billing invoices in a timely manner.• Solve problems quickly, independently, and to a high standard.

Columbus, Ohio Metropolitan Area

• Obtained and maintained required state insurance licensing to conduct business.• Set up renewal packets for the insured including statement of values, business income worksheets, and payroll projections.• Understand and explain the rating factors to clients as well as determining and presenting available payment methods to clients.• Provide binders, evidence of insurance, and certificate of insurance to clients and holders.• Set up hard copies of policy binders as well as proposals to deliver and explain policy to policyholder, provide relevant disclosures, and summarize the client’s insurance policy. • Process ACORD change requests, cancelation requests, audits, endorsements, auto ID’s, and run motor vehicle reports based on underwriting guidelines for midterm endorsements.• Request loss runs from prior term years and obtain AOR letters as needed.• Train new hires on commercial property and casualty general processing within the agency.• Original founder of the Columbus Culture Committee within the agency and creator of the Weekly Spotlight Newsletter featuring Tips/Tricks, Office Announcements, Employee Bios, and Office Events.• Review polices and checking them as they are received to ensure proper coverage. • Set up finance agreements with client and financing company. • Ensure Surplus Lines taxes are processed.

New Albany, Ohio

• Analyzes and authorizes claims and determines benefits due based on client plans.• Facilitates claim resolutions with claimant, client, medical provider, or other parties involved with claim.• Ensures claims are filled, coded, and processed correctly and adequate documentation is in the claim.• Knowledge and understanding of ERISA, FMLA, ADAAA, URAC, disability, and basic clinical terminology, IC-10 coding, as well as basic worker’s compensation knowledge.• Determines benefits due and makes timely decisions on payments following federal, state, and client specific guidelines.• Processes benefits due and makes appropriate adjustments for workers compensation, social security disability income, state disability income, and other disability offsets.• Research, resolve, and administer escalated inquirers for all lines of business for leave of absence, accommodations, and disability.• Follow up phone and written communications to claimant, client, and medical providers to ensure customer satisfaction.• Provides error correct of complex and high exposure claims.• Decision authority level to move the call forward and issue resolution.• Provide coaching, leadership, guidance, and support to ensure proper procedures are being implemented and followed.• Assist with development and improvement of current work processes to further ensure customer service objectives and levels are met.• Authorization to issue payments off cycle to claimants who are experiencing financial hardships.• Correct and process over and under payment errors on benefits paid out.

Hilliard, Ohio

• Oversee and manage over 100 complex disability claims and their concurrent federal, state, company, and policy claims.• Contact all parties to the claim within 24 hours of receiving a claim.• Explain the State and Federal laws and regulations along with client policies to claimant. • Contact all treating providers to obtain office visit notes, diagnostic test results and therapy notes. • Review medical within 24 hours of receipt and take appropriate action such as approving, denying, seeking clarification/deficiency, or sending for nurse review. • Seek objective medical findings from medical providers for projected number of days needed to recover and release back to work.• Oversee payable benefits and state disability insurance offsets.• Manage restrictions, reduced work schedules, and full duty return to work.• Contact claimant and client at least every 10 days to provide pertinent claim updates, changes, decisions and other important information regarding the claim. • Document all case management activities within the claim – not limited to phone, email, web, fax and postal mail correspondences.• Facilitate transition into long-term disability insurance companies and job accommodations company (Americans with Disabilities Act).• Make timely decisions on claims within 21 days of receipt.• Facilitate training of new colleagues and ensuring the clients polices and companies policies are met and surpassing expectations.• Work with the Director of Operations to facilitate creating new positions, consolidating positions, and updating work processes to ensure efficient claims management.• Adhere to all federal, state, client, and company laws, regulations, and policies. • Review claims for subrogation and compliance

Dublin, Ohio

• Contact all parties to the workers’ compensation claim within 48 hours of receiving a claim.• Act as an advocate for employee and injured workers’ concerns. • Obtain basic demographic, injury related data and claimant/employee policy information.• Inform injured claimant of BWC certified providers and locations should claimant need a new doctor.• Contact provider offices to obtain any and all medical records related to the injury and confirms follow up appointments and treatments.• Address provider requests for medical treatment on C9 forms for durable medical equipment, MRI/CT/Xrays, physical/occupational therapy, consults, and date extensions as needed within 72 hours if warranted/necessary for allowed conditions to the claim. • Seek objective medical findings from providers for projected number of days needed to recover, release to return to work, and/or Maximum Medial Improvement. • Contact all parties of the claim at least every 30 days to provide updates and progress of recovery.• Address additional conditions requesting to be added to the claim and sending for nurse review and BWC determination.• If indicated – offers vocational rehabilitation services to employee or representative.• Initiate utilization review, claim holds, drug risk assessments as needed.• Contact the Third Party Administrator for red flags and if the employer wants to contest aspects of the claim or the whole claim.• Document any and all case management activities within the claim.• Conduct limited on going assessments to determine ability of injured worker to return to preinjury position, transitional duty or alternative job with same employer.• Accountable for adherence to all applicable laws and regulation of the BWC MCO position.• Ensure high quality, cost effective, and timely provision of medical care.• Refer claims based on injury to nurse case manager or CAT (catastrophic) team. • Able to effectively manage 114 clients with over 400 claims.

Columbus, Ohio Area

- Build new basic and complex Leave of Absence, Disability, and Workers Compensation Claims - Has direct communication with colleagues and clients, both written and oral, to obtain information for claims processing- Assist colleagues and Team Leads with administrative tasks and urgent claim build requests- Explains benefits and eligibility to clients- Appropriately handles confidential information received from speaking with and corresponding with physicians’ offices and clients human resources departments - Trains/mentors new employees on the claims system and company department procedures- Manages a book of fifteen clients, balancing multiple tasks while maintaining the quality, service, and expertise of the Sedgwick Core Values- Suggested changing multiple inefficient procedures/processes which was accepted by management- Work in conjunction with new clients to tailor the system to their needs- Meeting multiple deadlines throughout everyday for each client that I handle as well as supporting other claims assistants in meeting their expectations for their clients- Maintaining 100% on my audits and attendance since date of hire- Assign the correct Leave of Absence or Disability examiner to claims that have failed to auto-triage out or are assigned to the incorrect examiner

4409 North High Street

- Maintained patient accounts by obtaining, recording, and updating personal and financial information as well as assisting office manager with medical coding and insurance forms.- Ensured availability of treatment information by filing and retrieving patient records; contacting insurance companies to monitor claims processes- Welcomed patients and visitors by greeting in person or on the telephone, answering or referring inquiries- Optimized patients’ satisfaction, provider time, and treatment room utilization by scheduling appointments in person or by telephone- Kept patient appointments on schedule by notifying provider of patients arrival; reviewing service delivery compared to schedule; reminding provider of service delays- Comforted patients by anticipating patients anxieties; answering patients questions; and assisting with healthy education through pamphlets- Ensured availability of treatment information by filing and retrieving patient records; contacting insurance companies to monitor claims processes- Created and oversaw invoices and work with patients to develop payment plans and process all therapeutic purchases- Ensured a safe and healthy waiting room by establishing, following and enforcing sanitation standards and procedures complying with health and legal regulations

Oversaw receptionist area including greeting visitors and vendors and responding timely to telephone and in person requests for informationCoordinate inventory orders, schedule deliveries and return on supply purchases and mail distribution Created and oversaw invoices and assisted clients to create payment plans and process all purchases and refundsMaintained client and staff databases for mailing and communication purposes utilizing spreadsheets and MS Excel

Increased effectiveness by hiring, training, and disciplining; communicating values; strategies and objectives; assigning accountabilities; planned and monitored and apprised job results and developed incentivesIdentified and evaluated competitors in the community to prepare marketing strategies and monthly eventsAttracted patrons by developing and implementing marketing and advertising ideas; identified changing demands to generate repeat and referral business; surpassed monthly sales goals by at least 10%Controlled purchases and inventory by negotiating prices and contracts; developed buyers listsMaintained operations for a safe and clean establishment by preparing policies and standards of health and code enforcement laws

Insurance

Insurance Essentials

Education record

Diploma, Honor Roll

Activities and Societies: Anime club, dance club, women's glee, symphonic choir, freshman choir, ensemble choir