Sue Maddock Email & Phone Number

Cleveland/Akron, Ohio Area

*Managed Quality Assurance auditing of claims, customer and membership service. Established and implemented auditing protocols.*Developed comprehensive training program to improve skills, knowledge and create positive impact on performance and development.*Assumed regional project management roles for corporate initiatives. *Managed implementation of benefit plans in claims system for new clients and enhancements for existing clients.*Oversaw self-funded claim filings and carrier audits.

*Conducted Specific and Aggregate claims audits on behalf of insurance companies. Ensured claims were processed in accordance with policy provisions.*Monitored ongoing eligibility of claimants in accordance with policy terms and provisions. Recommended plan amendments to recognize clients’ benefit continuation policies.*Participated in monthly Claims Loss Control Committee meeting to identify and manage potential catastrophic loss claimants, third party liability issues, and compliance with plan provisions.*Assisted in special analytical, statistical, auditing and research projects. Recommended system and procedural improvement that enhanced overall business processes.

*Managed claims processing department for the administration of medical, dental and vision benefit plans. Developed and maintained ongoing staff training and auditing protocols.*Client account management including implementation, benefit plan design, PPO and Utilization Review vendor contracting.