Stephen D. Holmes, Cpcu Email & Phone Number

Chapel Hill, Nc, Us

Raleigh-Durham, North Carolina Area

Responsible for oversight and management of day-to-day operations related to compliance, quality assurance and training for the Claims Department. Compliance:•Keep apprised of regulatory/legislative changes and provide handling recommendations. •Utilize outside defense counsel as needed. •Co-chair corporate Compliance Council. •Partner in creating company-wide Compliance SharePoint resource. •Respond to inquiries from regulatory authorities regarding reports, data calls, audits, market conduct examinations and state DOI complaints. •Created and staffed new Medicare Compliance Analyst position. •Designed and implemented department-wide Medicare claim handling best practices.•Shifted MSP compliance handling in-house to reduce expenses and increase technical expertise. •Implemented new approach to WC Medicare Set-Asides resulting in considerable cost savings. •Solution and begin historical claims clean-up related to Medicare compliance. •Manage ISO claim submissions and overall administration. Quality Assurance:•Established new QA file quality guidelines and intents for W.C. and Commercial departments. •Automated various departmental reports and incorporated with Power BI where possible. •Enhanced claims customer satisfaction survey process providing unit and adjuster scores. Training:•Work with Claims Trainer to identify training needs and develop training plans for all new hires.•Update and promote Claims SharePoint site as primary departmental resource. •Work with Claims Trainer to monitor capacity to better determine future resource needs. Cross Functional:•Enterprise Risk Management: founding member of ERM Team developing corporate ERM framework.•DE&I Council – Contribute in the development of corporate DEI program: create and lead DEI events, assist in overall messaging, socialize DEI opportunities to increase participation. •Provided claims expertise for sales large market account rebranding project.

Morrisville, Nc

Created and rolled out Medicare claim handling process and managed overall Medicare Section 111 and MSP compliance. Participating in various types of QA reviews. •Created and implemented end-to-end Medicare handling process ensuring compliance with federally mandated Section 111 reporting and proper front-line claims handling.•Managed Bodily Injury & No-Fault MSP (Medicare Secondary Payer) responses.•Completed QA Business Unit Reviews both to ensure compliance and improve performance. •Performed targeted reviews analyzing Business Unit performance in specific areas. •Reviewed injury evaluations providing analysis and settlement recommendations. •Led settlement conferences with adjusters/managers assessing claim resolution opportunities.•Reviewed claim files and bodily injury evaluations completed by claims adjusters providing them with analysis and recommendations concerning file quality and claim value.

Raleigh-Durham, North Carolina Area

Adjusted commercial claims of varying claim types in multiple jurisdictions.•Adjusted commercial lines casualty bodily injury and property damage claims in the states of NC, SC, TN, FL, KY, MS, AL, GA, AR, CT, MA, OH.•Claim types handled include: Commercial Auto, Garage Owners, General Liability PD, General Liability BI (Foreign Object, Foodborne Illness, Allergies).•Panelist with Arbitration Forums hearing cases monthly, aiding the National Recovery Team.•Graduate of the 2017 Nationwide Emerging Leaders Program.

Raleigh-Durham, North Carolina Area

Adjusted personal lines bodily injury and property damage claims. •Handled BI Medicare claims which included opening new cases with CMS, ensuring that CMS liens were appropriately addressed and obtaining CMS case closure documentation.•Provided on-going direct mentoring for peers. Collaborated in the creation of a new program preparing associates in other claim functions to transition to BI; acted as the programs first one-on-one mentor. •Conducted associate trainings in: BI Evaluations, BI Negotiations, Reservation of Rights and Excess letters, Global Settlements, Negotiating Medical Bills.•Led nine Associates in a Customer Service Forum to improve customer experience and survey scores. •Served as acting Non-Injury Manager: 2/16/17--2/17/17, 3/24/17--3/27/17, 8/21/17--8/25/17.•Created phone scripting reference guide for new claims associates. •Panelist with Arbitration Forums hearing an average of six cases monthly. •Wrote SC release language addendum regarding the payment of medical bills. •Compiled medical provider fee limitations document for NC and SC. •Secured bill reductions: $35,398 in 2017 and $9,077 in 2016.

Founded non-denominational church and served as Executive Pastor.•Led group of 10-12 volunteers executing organizational priorities. •Gave weekly teachings comprised of written material and PowerPoint presentations. •Raised awareness for social issues e.g., human trafficking and clean water projects.

•With an individual authority of $25,000 adjusted liability bodily injury and property damage claims; routinely handled claims with values up to or in excess of $100,000.•Primarily handled claims from NC, SC and TN; on occasion handled claims from NJ, VA, GA, FL and LA. •Litigated files typically comprised 25% of caseload. Worked with defense counsel to establish litigation strategy, attended court-ordered settlement mediations, monitored jury trials and provided comprehensive analyses of claim settlement value and potential jury awards. •Worked remotely from home office for four years.

Master Of Arts (M.A.), Liberal Arts And Sciences/Liberal Studies

Bachelor Of Arts (B.A.), Magna Cum Laude, Theology/Theological Studies, 3.8 Gpa

Activities and Societies: Alpha Gamma Chi Chaplain, 2001