Andrea Munson Email and Phone Number

Responsible for compliance corrections activity specific to its Medicare & Retirement operations. Accountable for documenting, tracking and trending issues and associated remediation as identified through compliance and/or business activities; developing reporting and communications of identified issues to internal and external partners; validating the implementation of corrective measures; and management of program level improvement initiatives.

Responsible for the investigation and recommended resolution of allegations of Medicare agent/broker misrepresentation or misconduct related to sales and marketing activity. This includes analysis of initial allegation, collection of pertinent information and documents, preparing written requests for information and conducting interviews of individuals with pertinent information regarding the allegations. Duties include: reviewing and investigating member complaints from a variety of sources; investigating both standard and non-standard requests and/or complaints; conducting interviews of agents, members and other parties and generating necessary documentation and reports supporting findings; gathering and examining documentary evidence and information from data bases; preparing detailed case summaries and organizing and presenting exhibits in support of findings, researching and analyzing data from various applications and databases to support conclusions and / or outcomes; researching, reviewing, and applying regulatory requirements, including internal UHC policies and procedures as well as CMS marketing guidelines to case investigation processes for supported outcomes, using pertinent data and facts to identify and solve a range of problems within area of expertise including patterns and trends of identified events; prioritizing and organizing assigned cases to meet both formal and informal deadlines and turnaround time expectations.

Conducts investigation on assigned cases, confirms coverage, determines liability, identifies subrogation rights, establishes damages, prepares for arbitration, reports status, and negotiates settlement (has authority to make payment of assigned claims within prescribed limits). Determines and reports on subrogation potential. Performs most duties on an individual basis, and work has a direct bearing on Management results. Contacts are a major part of activity and include policyholders, claimants, agents, witnesses, police and fire departments, special investigators, attorneys, members of the medical profession and all other persons incident to the investigation and processing of claims. Extensive knowledge of North Dakota and Minnesota. Awarded a Superior Service Award.

Started, renewed and maintained car and renters insurance polices. Work extensively with customers and also handled claim reports. Became certified to use the Atlantic Trust software system by completing the training course and attending a workshop. Prepared lien holder letters, sent reminders, worked with collection agencies and took policy payments. The job also consisted of answering the phones and the use of a variety of computer and internet programs.