Partnered with senior leaders, business leaders, vendors, compliance and legal to help solve organizational challenges and implement strategies that enhance the performance of the claims department. Communicated successfully utilizing verbal and written communications to depict and defend points of view to business leaders and team members transferring knowledge, skills, and tools. Ensured cross functional alignment of goals and execution and helped drive strategic partnerships and new initiatives. • Adapted consulting style and approached to the culture of each business unit and share mindset, skills and tools to ensure sustainable results.• Continually developed and applied broad organizational knowledge to address business challenges.• Developed strategies that assess and increase efficiency, effectiveness, and process improvements (Straight Through Processing for First Party bill review, PPO/ Voluntary Provider Network Optimization, Script Advisor/Pharmacy Benefit Optimization).• Researched and collaborated with data analytics to gain and develop insight to formulate recommendations for business.• Developed strategies to drive organizational change readiness and facilitate mindset/behavior shifts across a diverse set of stakeholders.• Served as Mitchell (Decision Point) and Medlogix account administrator, IME Vendor Administrator, and Smart Comm Template Admin.• Solutioned for Michigan SB1 changes; worked with product on updated language for policy filing, trained staff about fee schedule, created Utilization Review Plan and worked with vendor to acquire additional services for same.• LOB functional Lead for MCCA Automation Project.• Led Project Team to redesign PIP LOB Training Curriculum.• Led process review to optimization handling of FL PSD.• Acted as Strategy Consultant for FL PIP Litigation (Billed Amount, Limiting Charge, BNU).

Managed a unit of 10 No-Fault Adjusters handling Fl, NY & NJ claims from inception to close, including claims litigation. Reviewed files for accuracy and completion including reserving, communication, documentation, evaluation, negotiation and settlement (when applicable). Participated directly in the adjustment of complex or unusual claims (coverage issues, SIU, Serious loss/fatalities). Analyzed and approved claim settlements and coverage determinations. • Created National Standard of Work and State guides and training for NY/NJ PIP. • Collaborated senior management and product to determine best course of action for our DPR when submitting plan changes to NJDOBI for approval when Regulatory updates occur • Collaborated wit SIU, and BLO employees to formulate action plans and develop claim handling processes in the best interest of the company. • PIP UAT Lead GWCC- wrote and executed test cases, supervise a team of 8 PIP CR’s who are testing, file defects, review defects with business leads, IT and vendors as appropriate. Inform management of changes that will affect PIP and provide recommendations for new procedures and workflow. Led meetings to ensure reporting that needed to be implemented for MI MCCA. • Temporary PIP strategy lead for Farmers (July 2018- Oct 2018) - involved in the design or modification of business systems and/or IT systems (GWCC and Mitchell). Interacted with the business stakeholders and subject matter experts in order to understand their problems and needs. Gathered, documented, and analyzed business needs and requirements. Escalated issues to senior project managers as needed. Organized meetings between business, vendors and IT. Ensured compliance with any strategies. Reviewed, managed, and analyzed existing business strategies in order to provide council to the business's leadership and ensure alignment with the business's overall. Helped implement strategy for Farmers NJ commercial auto coverage’s, Medicare, and HPCS decommission.

Evaluates Personal Injury Protection (PIP) and Med Pay claims for eligibility, medical necessity, andappropriateness of charges in accordance with state fee schedules. Determines relatedness, causation, and appropriateness of treatment based on the compensable injury. Provides reserve recommendations and makes payment approval to ensure activities are consistent with corporate policies. Confers with legal counsel on claims requiring litigation. Conducts detail bill reviews to implement sound litigation management and expense control.Process claims within designated authority levels. May assist personnel as directed with answers to technical claims questions and decisions as to claim file activity. May be assigned the responsibility of training new claims representatives. Makes contacts with stakeholders to investigate and process claims. Contacts may include multiple attempts to communicate with various parties and requires telephone conversations or other methods of communication to be a priority. Parties involved could include policy holders, claimants, agents, witnesses, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and other persons pertaining to the investigation and processing of claims.