Margaret (Peggy) Butwin, Ltcp, Hcafa Email & Phone Number

United States

Chicago, Illinois, Us

With a primary focus on Long Term Care claim fraud, responsible for the identification, analysis, investigation management and resolution of suspect claims for CNA’s LTC Fraud, Waste and Abuse (FWA) program.

Newark, New Jersey, Us

Responsible for investigating allegations of, among other things, fraud and sales practice misconduct, conflicts of interest, privacy and other matters relating to improper conduct involving employees, third party entities and vendors.

Newark, New Jersey, Us

Review corporate information, documentation and internal controls to determine risk of exposure to potential fraudulent activities.Assess identified risks related to fraud and determine compliance with legal/regulatory responsibilities. Recommend improvements or refinements of internal controls and operational enhancements to mitigate risks of potentially fraudulent activities. Cultivate and maintain relationships within Prudential and externally (through industry groups, peers, etc.) to remain current with advances in internal/external controls and fraud detection systems.Design applicable training and act as subject matter expert to educate the teams on current trends and tools. Monitor and investigate allegations of fraudulent activities by developing, implementing and maintaining suspicious activity monitoring reports. Respond to requests from employees, management, internal audit and regulators on suspicious activities or reporting matters.Review documents such as emails, transaction records, correspondence, and other information to identify evidence of inappropriate or potentially fraudulent activity.Conduct interviews to uncover new information, clarify or corroborate investigation findings.Maintain appropriate documentation and files to prepare a body of evidence to support potential legal proceedings.Work with Management and CID’s Special Investigations Unit on case monitoring and investigations. Report and communicate findings of investigationsWork with Legal, Compliance, and Risk Officers, Internal Auditors to take corrective action or protect against potential fraud.Communicate and report appropriate reporting policies and procedures. Work with Special Investigations Unit to prepare investigative reports that provide details of the investigation, findings and recommendations. Represent LTC Claims in a courtroom setting when required

Newark, New Jersey, Us

Manages caseload of long term care claims and evaluates claim eligibility. Interacts with internal and external customers including, but not limited to, claimants, agents, benefit access staff, service and underwriters to gather the information to make the decision on the claim. Analyzes, approves or denies claims for contestable and non-contestable cases. Provides technical direction to other claims personnel as needed. Makes payment decision, follows up and monitors payment accuracy and timeliness; follows claim to closure.Responsibilities also include the handling of tax related issues for Long Term Care (W-9's, B Notices, 1099-LTC and 1099-MISC), and LTC Fraud investigation."Prior to my taking early retirement to care for my wife, I spent forty years managing operations and technology for a number of banks and insurance companies and in that career I managed many call centers, customer service functions and claims processing departments. In any of those situations, I would have been proud to work with Peg and would felt that the company was fortunate to have her on the team..." - LTC Customer "Seldom have I encountered in the private or public sector an employee as professional and dedicated as Peggy Butwin. I truly cannot emphasize how impressed I am with Ms. Butwin. Because of the manner in which she represented your firm, I have already recommended Prudential to four people who are seeking to purchase various insurance products. Ms. Butwin possesses the attributes that true "goodwill ambassadors" should demonstrate when interacting with clients..." - LTC Customer

Newark, New Jersey, Us

Newark, New Jersey, Us

Newark, New Jersey, Us

Was initially hired as strictly Customer Service for the DMO plan members, but quickly moved to Provider Relations due to consistently proven customer service skills. Also, adjudicated Dental Claims and provided emergency authorizations in certain situations.