Lorene Johnson Email & Phone Number

Primary responsibilities and key successes included: Managed NJ and PA Medpay Claims from initial set up to closure, perform extensive investigation using various search engines, perform verbal contact with insureds/claimants, determine coverage or identify red flags to institute a special investigation to confirm coverage or deny due to a voidance of the.

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• Special assignment with the responsibility for managing medical services to the Association, e.g., Independent Medical Examinations (IME) coordination, selection, and establishment of medical doctor review (MDR).
• Directed the audit of files related to medical and claims management;
• Ensured compliance of applicable statutory and regulatory requirement, as well as industry best practices;
• Assisted Director in the development, implementation, monitoring, and supervision of vendor compliance with NJPLIGA requirements;
• Monitored and ensured compliance with established standards of performance, policies and procedures to achieve set objectives;
• Assisted with special projects, training, workflow and oversight, as warranted.

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• Manage the day-to-day PIP claims operations, ranging from routine to complex, ensuring highest quality customer service. Primary responsibilities and successes have included:
• Provide oversight, development, and evaluation of all staff within unit;
• Effectively assign and balance workflows for all staff;
• Developed and implemented best-practice PIP claims management process;
• Review, revise, and deliver training programs for staff throughout performance cycle;
• Other core responsibilities include: effectively control cost for the Association; perform periodic file audits to ensure high quality and integrity of claims management process; monitor and evaluate selected vendors.

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• Manage and supervise staff of a new unit that provides technical assistance to examiners in the areas of cost containment, PIP coverage, arbitration, litigation and collection;
• Review and approve closed files and direct for further due diligence as warranted, i.e., collection handling;
• Created workflows, policies and procedures and established metrics for successful performance management;
• Trained unit members on all aspects of claims processing, coverage problems and associated issue resolution; developed unit members to transition into examiners.

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