Dorothy Crouch Email & Phone Number

Working within the Products and Compliance team we focus on market segments and cultivate opportunities with outside vendors to assist with product updates/new product initiatives.✔Present any product-specific Future Change requests in kick-off meetings. ✔Document any approved product-specific Future Change requests or Annual Standard Language. ✔Updates in the Business Requirements Document.✔Works with internal and external partners to ensure communications across the board.

Managed multiple accounts within IMG's iTravelInsured® subsidiary. Aided clients in understanding their benefits. Acted as a liaison between clients and all internal departments to service the accounts. Facilitated services needed for claims and questions regarding benefits. Managed service, billing, claims and enrollment issues.✔ Reviewed insurance policies and endorsements, ensuring adequacy and accuracy of documents.✔ Managing implementations of new lines of coverage and carrier changes with clients, ensuring clients have a smooth onboarding process.✔ Developed and implemented account plans to drive business objectives and revenue growth.

Supported multiple IMG business units with claims and policy management through a team of nearly 60 professionals (7 direct reports) and managing/reviewing a $2.5 M budget. Managed production of each operational unit by analyzing the claims dashboard daily and reported KPIs to executives. Key stakeholder in managing multiple simultaneous projects, providing feedback and direction, working directly with internal and external clients. Served as authorization for specific exceptions to IMG's claims payment process.✔ Doubled the staff to meet service level agreement requirements, retaining a low turnover rate.✔ Increased claims production per hour from 3 to 6 by automating processes and piloting a work from home flexible schedule before Covid hit. Still maintained a 99% accuracy level on claims.✔ Improved department efficiencies by creating two new units, medical records review and training, and establishing a business analyst position.✔ Initiated and led a massive cross-training project to eliminate all single points of failure, resulting in backing up every unit in the department.✔ Mentored supervisors and team leaders, enabling them to run their units effectively and preparing them for growth opportunities.✔ Outsourced basic claims processing, allowing staff to concentrate on more complex issues.

Greater Indianapolis

A full-service travel medical company assisting with domestic or international travel. HCC Medical Insurance was acquired by Tokio Marine and now operates as WorldTrips Travel Insurance. Investigated claims according to the policy provisions and adjudicated claims. Participated in special project by beta testing system enhancements.✔ Often exceeded production and audit requirements.✔ Trained new hires on system and processes.✔ Reduced claims inventory by writing queries to identify oldest claims and begin processing.✔ Trained new hires, a supervisor and team lead, ensuring a uniform knowledge base.

Managed, tested, and developed claims system, eligibility system, underwriting system implementation. Developed policy wording, schedule of benefits, and claims processing procedures. Verified patient account, eligibility, benefits, and authorization information. Analyzed the information to determine payment amount or denial of payment. Reviewed “daily processor” report for accuracy of claims entry (review CPT/ ICD-9 coding) and made corrections as necessary. Corresponded with medical providers regarding billing procedures, benefit coverage, reimbursement issues, and claim status.Reviewed medical claim appeals and notified results to provider/patient.✔ Visited and liaised with brokers to encourage the introduction of new insurance products to their clients.✔ Developed website, online application process, and conducted beta testing.✔ Handled and responded to product queries from clients quickly, efficiently and accurately.✔ Verified and analyzed data used in settling claims to ensure claims were valid and settlements were made according to company practices and procedures.✔ Examined claims investigated by insurance adjusters and further investigated questionable claims to determine whether to authorize payments.

Supervised a department of 7 employees. Recruited, selected, and trained qualified candidates to fill organizational requirements. Created yearly business plans, budgets, and schedules for the department, and prepared presentations for quarterly managers meetings. ✔ Traveled and consulted with clients to improve service/product process.✔ Increased productivity by streamlining departmental procedures. ✔ Regularly demonstrated the ability to resolve customer/employee issues and disputes in a professional manner.

Communicated with medical facilities to place a guarantee of claims payment. Developed cost estimates, negotiated discounts, and obtained medical information to make determination on processing claims. Created billing reports, processed claims, and generated billing reports.✔ Provided international travel assistance and repatriation guidance for medical emergencies.✔ Verified and analyzed data used in settling claims to ensure claims were valid and settlements were made according to company practices and procedures