Sue Hensley Email and Phone Number

Plan and direct the Medical Data Call and Indemnity Data Call functions. Monitor the timely and accurate collection of medical transaction data using the WCIO WCMED record and act as a subject matter expert in workers' compensation medical billing and claims handling practices. Monitor the timely and accurate collection of Indemnity data using the IAIABC FROI & SROI reporting and act as subject matter expert in California workers' compensation claims handling practices. Advise the Research and Actuarial teams on claim handling dynamics and detailed claim data for usage in research and modeling

Management of team responsible for data submissions of policy, unit statistical/loss reporting and medical transaction data for the California Workers' Compensation system for the purposes of pure premium ratemaking, experience modification generation and research. Specific area of expertise is medical transaction data. Interface with insurer members to ensure quality data reporting including remediation plans as needed.Extensive data mining utilizing SQL, Cognos and proprietary data validation tools.

Manage corporate division responsible for establishing policy, procedure and guidelines for bill processing and lien handling including vendor management system oversight, bill review software system support and maintenance, and exception reimbursement authorization procedures. Collaborate with IT, Legal and bill review software partner to write software rules to enforce payment policies. Provide oversight for timely implementation of all new regulations associated with medical billing and reimbursement. Manage global lien settlement program including analysis of outstanding A/R and coordination with corporate Legal Department to negotiate settlement to avoid individual case-by-case basis litigation. Fulfill role of PMK in civil litigation regarding reimbursement issues