Sandy Lachowsky Email & Phone Number

Kirkland, Wa, Us

Greater Seattle Area

Research and responds to claim referrals through ticket tracking system from processors and Client Services. Investigates, confirms subrogation potential, establishes fair recoveries and negotiates settlement of subrogation claims. Refer cases outside of authority level, preparing referral documentation and materials as appropriate. Investigate, negotiate and resolve claims, involving complex issues. Develop, nurture and maintain strong relationships both internally and externally. Support training, developing and coaching of less experienced staff. Assist Time Loss Department with disability claims in reference to workers compensation claims. Update procedural manuals, provide ongoing training, and conduct presentations. Monitor backlog to maintain timely requirements within the Department of Labor guidelines for self-insured health plans. Assess, change and update internal processes to allow better results of third party claim procedures.

Boise, Idaho Area

Analyze consumer complaints related to the regulated insurance industries todetermine whether a violation of law or contract provision occurred. Negotiated resolution of filed complaints. Investigated code violation cases. Responded to technical questions from insurance companies, adjusters, and brokers. Reviewed industry trends, innovations, related legislation and court rulings. Provided input in revising department regulations, health insurance laws, and writteninterpretations. Made oral presentations to regulated industries and consumer groups. Reviewed insurance policies and related documents to assure compliance with stateinsurance laws and regulations. Served as an active member on health insurance committees revising existinginsurance laws, contracts to better serve the public. Assisted with insurance form filings by reviewing existing insurance policies waitingapproval from the Commissioner of Insurance. Testified in hearings and in court. Assisted the Governors Office and State Attorney Generals office as requested

Boise, Idaho Area

Initiated and maintained communications with laws enforcement and appropriateregulatory agencies including presenting or assisting with presenting investigation orcase findings for their consideration to further investigate, prosecute, or seek otherappropriate regulatory or administrative remedies. Drafted investigation reports, evaluates investigation reports, and promotes effectiveand efficient investigations. Testified at various legal proceedings as necessary. Created and maintained computerized record management systems to record andprocess data and generate reports. Conducted quarterly desk audits from medical providers looking for trends ofpotential fraudulent wasteful and abusive billing practices. Participated in stings and surveillance in regards to fraudulent insurance dealings.

Boise, Idaho Area

Hired, terminated, and trained staff. Supervised a staff of eight (8). Supervised billing, coding, and collections. Scheduled appointments, maintained medical records, and made deposits. Skillfully developed goals, objectives, standards of performance, policies andprocedures. Responsible for day to day operations for a large medical practice.

Boise, Idaho Area

Managed wide variety of customer service and administrative tasks to resolvecustomer issues quickly and efficiently. Ensured superior customer experience by addressing customer concerns,demonstrating empathy and resolving problems on the spot. Routinely answered customer questions regarding products and premiums. Investigated and resolved customer inquiries and complaints in a timely andempathetic manner. Answered an average of 98 calls per day by addressing customer inquiries, solvingproblems and providing new product information. Recipient of multiple positive reviews acknowledging dedication to excellent customerservice. Precisely completed appropriate claims paperwork, documentation and system entry. Correctly coded and processed medical claims for various facilities.