Matthew Shedd Email & Phone Number

Utica, Ny, Us

Us

Coordinate and create value added processes. Identifying opportunities for efficiencies. Developing action plans surrounding project scope, targeting milestones and remaining within budget.Meeting and exceeding quality standards while cooperating in accordance with applicable laws, state regulations and carrier guidelines. Proactively identify and address areas of risk and provide recommendations for remediation.

Us

Providing leadership and management to the operational team.Building and developing a strong team, development of relationships and partnerships with brokers, insurance carriers and vendors.Grow the efficiency of the existing organizational processes and procedures.

Supervision• Provide supervision of Claim Department, Quality Assurance, Policyholder Services, Call Center, Corporate Purchasing • Coordination of employee hiring, reviews and discipline (27 employees)• Achieve levels of staffing, production, quality and expense• Develop expectations and goals and provide direction of Claim Management TeamProduct Lines• Coordination of all aspects including adjudication, appeals, compliance of K-12, College Accident and Sickness and Special Risk Claim AdjudicationRe-pricing Relationships• Established Emdeon and Gateway Payor IDs• Coordinated Team - Cigna PPO & Cigna Rx Implementation/Integration of admin system• Coordination of OptumRx PBM• Negotiated/developed claim re-pricing relationship with Zelis Healthcare• Developed EDI Capabilities on behalf of the Company and established relationship with Zelis Healthcare’s subsidiary- PayPlusAudits• Coordination of tri-annual audits of NYS Insurance Department• Coordination of all state insurance department audits• Coordination of all internal audits with Ernst & Young as well as corporate internal auditAdministration• Coordination of claim and procedure manual• Monitoring prompt pay of claims• Develop reporting aids to statistically manage employees and blocks of business• Develop production benchmarks for departmental goals• Coordinate employee performance reviews• Coordinate PBM relationships and overrides• Coordination of corporate reinsurance treaties, administration and billingReinsurance• Coordination of corporate reinsurance treaties, administration and billing• Established production benchmarks for examiners, validation and call center• Member of corporate RIM Committee for record retention and corporate policy

Corporate Officer - Provide supervision of Claim Department, Policyholder Services, Call Center, Building & Maintenance, Corporate PurchasingVetted claim administration solutions for Corporate Executive and Budget CommitteesCoordinating implementation of new claim administration system - Cognizant Trizetto SolutionMember of the steering committee - governance for the implementation team of Trizetto SolutionCoordinating the vetting of RedCard Solution for ID Cards, EOBs and PaymentsCoordinating CIGNA PPO Implementation on behalf of Division/CompanyCoordinating CIGNA Rx PBM Implementation for CompanyCoordinating Optum Rx PBM on behalf of the Division/CompanyCoordinating Claim Administration System due diligence on behalf of Division/CompanyCoordinated the development of EDI capabilities for Claims DepartmentEstablished Emdeon and Gateway Payor IDsCoordinated PayPlus Electronic Provider Payment CapabilitiesCoordinated mapping 835 and 837 records for EOBsContracted with Independent Medical Review and External Appeal Review firmsMember of the Corporate Incident Response CommitteeCoordinated scanning initiative for historical data with ComCom SystemsNegotiated automated claim re-pricing and bill edit and review with PHX - Zelis HealthcareCoordinate all aspects of K-12 and College Claim Adjudication ProcessingCoordinate claim administration of PPACA, Accident Only, Indemnity and Sports Plans Developed Claim Manual and Claim Procedure Manual for CompanyMember of Corporate RIM Committee for record retentionCoordinate Corporate Claims Committee for Internal Claims AppealsContracted /Coordinate Independent Medical Review for medical necessity determinationHigh Dollar Policy Review - College Medical Claims, TPA Claim ReferralsCoordinate NYS Insurance Department Audit - ClaimsCoordinate Internal Claim Complaint & Appeals - Student MedicalCoordinate Call Center Department Metric and Quality Assurance

Oversee the investment portfolios of the company. Purchase fixed income and equity securities to meet company cash flow requirements. Provide oversight of banking relationships and administer cash transactions for corporate accounts. Establish signature authority for corporate bank accounts. Present investment transactions to the Board of Directors on a quarterly basis. Procurement of office supplies and negotiate with vendors regarding pricing and quality of supplies. Provided oversight of the company's risk management portfolios.

Provided primary support for the corporate treasurer. Initiated bond purchases and trades. Accounted for daily cash management and corporate assets. Prepared trade memos to Accounting Departments.

Provided management of all aspects of the group insurance operations. Provided oversight of administration system, underwriting personnel, accounts receivable, billing and company conservation cycle. Provided primary support to claims in the adjudication of group life and disability claims. Administered reinsurance treaties. Developed various databases that provided internal reporting and proposal and reinsurance calculations. Provided support for corporate accounting department for year end processing, company audits. Administered rating software development and distribution to agents. Provided customer support for billing, commissions. Headed computer conversion to Y2k compliant administration system. Coordinated the development of all aspects of reporting including generating formats, interpreting departmental needs.

Bs, Accounting

As, Accounting