Summary
Overview
Work History
Education
Skills
Timeline
Generic

Anderson Grullon

Carlstadt,USA

Summary

Diligent and experienced Chief Risk Manager with 10 years of experience in risk management, claims management, and healthcare management. Proven track record of developing and implementing comprehensive risk management strategies, conducting thorough risk assessments, and collaborating with cross-functional teams to establish risk mitigation plans. Skilled in analyzing historical data trends for identifying emerging risks and maintaining documentation of all identified risks along with corresponding control measures. Achieved 25% reduction in overall organizational risks through successful implementation of risk mitigation strategies. Proficient in managing claim files from inception to closure, including coverage analysis, investigation, damages, and evaluation. Willing to relocate: Anywhere Authorized to work in the US for any employer

Overview

13
13
years of professional experience

Work History

Insurance Consultant

ICA Risk Management
11.2024 - Current
  • Oversee the daily management of a commercial lines book of business.
  • Conduct insurance reviews for contracts, including leases and loan documentation.
  • Coordinate and manage Certificate of Insurance (COI) requests from brokers.
  • Obtain and review loss runs, analyze insurance quotes and binders.
  • Educate clients on current market conditions and trends.
  • Assist in the preparation of insurance schedules and premium allocations using a rate matrix.
  • Maintain and update client statements of values and exposure data.
  • Track and follow up on outstanding requests with clients and brokers.
  • Develop and maintain an open items list to ensure timely completion of tasks.
  • Support marketing efforts for renewals and assist with additional special projects as needed.

Chief Risk Manager & Claims Director

CFG Health Network
04.2024 - 10.2024
  • Developed and implemented comprehensive risk management strategies to identify, assess, and mitigate potential risks
  • Conducted thorough risk assessments to evaluate the likelihood and impact of various risks on business operations
  • Collaborated with cross-functional teams to establish risk mitigation plans and ensure compliance with industry regulations
  • Led the development of risk management policies, procedures, and guidelines for the organization
  • Performed regular audits of internal processes to identify areas of vulnerability and recommend improvements
  • Monitored key risk indicators and implemented proactive measures to minimize potential losses or disruptions
  • Liaised with external stakeholders such as insurance providers, auditors, legal counsel, and regulatory agencies
  • Created detailed reports on identified risks, their potential impact, and recommended actions for senior management review
  • Collaborated with IT department to ensure data security measures were in place to protect against cyber threats or breaches
  • Drove continuous improvement initiatives by analyzing historical data trends for identifying emerging risks
  • Maintained documentation of all identified risks along with corresponding control measures
  • Achieved 25% reduction in overall organizational risks through successful implementation of risk mitigation strategies

Risk Manager ARM

Jacob K. Javits Convention Center
03.2020 - 04.2024
  • Responsible for servicing and managing relationship with key Captive and structured integrated accounts.
  • Partner with the functional stakeholders to design and continuously improves the ART team’s operating model and required investments.
  • Collaborate with the underwriting and distribution teams, including broker partners, to generate value-added alternative risk solution growth strategies.
  • Partner with underwriting and actuarial to assess pre-bind proposals, the account’s financial position, appropriate collateral requirements and the ability to execute on the agreements.
  • Partner with internal and external teams to oversee the on-boarding and serving of the captive accounts; including quarterly cessions and reporting and managing the collateral requirements.
  • Partner with Claims and the TPA’s to ensure timely and accurate claims settlements.
  • Supervise the collection of deductible billing recoveries. Work with the ART analyst and insured to resolve queries and manage outstanding balances.
  • Work with Underwriting, General Counsel and client to negotiate agreement changes due to program requirements or client request.
  • Works closely with Finance to structure deals appropriately, adhere to collateral management and credit policies and ensure the appropriate accounting for ART products.
  • Collaborate with state regulators and actuaries to review financial risk exposure levels and methods to manage exposure and appetite.
  • Handle internal and external audit inquiries as it pertains to the ART processes.
  • Provide industry, alternative risk, and client insights with the business, including understanding of latest insurance regulatory requirements.
  • Collaborate with other departments regarding risk related exposures, and provide general risk management support.
  • Meet with insurance adjusters and legal counsel to facilitate claim handling strategies.
  • Participate in safety committee meetings and risk management training programs.

Case Manager-Mental Health

Health First
06.2018 - 02.2020
  • Support individuals in pursuing their desired life outcomes by facilitating access to supports and services
  • Implement services in a collaborative manner involving the active participation of the individual, intended to assist individuals to enhance (not replace) their natural supports and other available resources
  • Serve as an advocate for the individual and report incident of neglect, abuse, or exploitation
  • Coordinate and monitor service delivery, including assuring services are delivered as described in the Individualized Service Plan (ISP) and are provided in a safe and healthy environment, through a formal, ongoing monitoring process.
  • Promote self-advocacy, advocate on behalf of the individual, as needed, monitor the health and safety of the individual
  • Hold a minimum of twelve face-to-face contact visits annually (1 per month) with each individual
  • Communicate with team members, facilitate and maintain communication with the individual or their representative, other team members, providers and other relevant parties to ensure the individual receives maximum benefit of their services and that any adjustments to the service plan are made as needed
  • Maintain accurate progress notes documenting every contact made related to the provision of services for the individual being served including telephone calls, face to face visits, participation in meetings, reviewing reports received, typing reports completed, attend meetings, travel, delivering needed documents, going to doctor office & hospitals to obtain medication information, going to office & other locations to obtain or deliver information on the individual served related to ongoing services.
  • Provide reports to team members, attending training, participating in audits, consultation or technical assistance, filing, billing, reviews, faxing copying, & mailing, completing level of care, individual service plans.
  • Complete progress notes, obtaining 3 hours of billable average across your caseload for the month.

Claims Manager/Examiner (Remote)

G4S Compliance & Investigations
11.2016 - 06.2018
  • Proactively manages claim files from inception to closure including coverage analysis, investigation, damages, and evaluation with some management supervision.
  • Liaise between the Carriers, TPAs, Insureds, and/or Claimants.
  • Establishes appropriate initial loss and expense reserves and continually evaluates the file on diary for adequacy, accuracy, and adherence to reserving guidelines.
  • Analyzes and interprets policy language in conjunction with specific loss facts to reach appropriate coverage decisions.
  • Drafts coverage correspondence including reservations of rights and coverage disclaimers in compliance with state statutes and regulations.
  • Compose correspondence to insureds, claimants, attorneys, agents, and regulatory agencies.
  • Appropriately and clearly documents all claim file activity, including current strategy, plan of action and maintain current diary according to claim handling best practices.
  • Work with and manage independent adjusters and experts and control costs of outside vendors
  • Effectively present cases within the department, and to underwriting and senior management.
  • Compose Large Loss Reports and other detailed reporting documents as appropriate on a regular and timely basis.
  • Identify subrogation opportunities and work with attorneys to obtain recoveries.

Claims Case Manager/Examiner (Remote)

R.M.G Investigation
03.2015 - 11.2016
  • Proactively manages claim files from inception to closure including coverage analysis, investigation, damages, and evaluation with some management supervision.
  • Liaise between the Carriers, TPAs, Insureds, and/or Claimants.
  • Establishes appropriate initial loss and expense reserves and continually evaluates the file on diary for adequacy, accuracy, and adherence to reserving guidelines.
  • Analyzes and interprets policy language in conjunction with specific loss facts to reach appropriate coverage decisions.
  • Drafts coverage correspondence including reservations of rights and coverage disclaimers in compliance with state statutes and regulations.
  • Compose correspondence to insureds, claimants, attorneys, agents, and regulatory agencies.
  • Appropriately and clearly documents all claim file activity, including current strategy, plan of action and maintain current diary according to claim handling best practices.
  • Work with and manage independent adjusters and experts and control costs of outside vendors
  • Effectively present cases within the department, and to underwriting and senior management.
  • Compose Large Loss Reports and other detailed reporting documents as appropriate on a regular and timely basis.
  • Identify subrogation opportunities and work with attorneys to obtain recoveries.

Claims Case CSR

State Farm Insurance
01.2013 - 03.2015
  • Investigate and interpret policy provisions, endorsements and conditions to determine coverage in the automobile property claim.
  • Identify and investigate Contested Coverage Claims with recommendation prepared for coverage committee.
  • Responsible investigating auto accident to make a liability assessment. This includes interviewing first and third party claimants, witnesses, investigating officers and other relevant parties, along with securing pertinent records, documentation and loss scene information.
  • Analyze the investigation to determine proximate cause, negligence, and damages. Evaluate and adjust reserves as necessary.
  • Prepare dispatch instructions for field personnel to inspect vehicles.
  • Negotiate and settle claims within his/her individual authority. Submit claims for approval to supervisor when over his/her authority or for guidance, review and/or referral when appropriate.
  • Maintain an effective follow-up system on pending files by advising insureds, claimants, and brokers on the status of the claim
  • Acts as an intermediary between the company, preferred vendors and customers, resolving any disputes that may arise.
  • Ensure that service, loss and expense control are maintained at all times
  • Adhere to privacy guidelines, law and regulations pertaining to claims handling.
  • Investigate and initiate subrogation when applicable. May handle and respond to special civil part lawsuits pertaining to property damage.
  • Participate in catastrophic claim handling as requested/needed. This may include traveling to other locations, extended hours and up to a three-week stay.
  • Handle our customer focused phone environment.
  • Other duties as assigned

Education

B.S. - Mechanical Engineering

Texas A & M - College Station
College Station, TX
05.2017

Skills

  • Risk management
  • Bilingual
  • Management (8 years)
  • Sales Management (5 years)
  • Medical Information (8 years)
  • Information security (8 years)
  • Hiring (3 years)
  • Risk Management (8 years)
  • Analysis skills
  • Comprehensive risk assessment
  • Oracle (5 years)
  • Operations management
  • E-commerce
  • Administrative Experience (8 years)
  • Project management
  • Pivot tables
  • Negotiation
  • Business management
  • CRM software
  • Microsoft Office (14 years)
  • Employee evaluation
  • Human resources
  • Management
  • Fraud prevention and detection
  • Benefits administration
  • Healthcare management
  • Marketing
  • Account management
  • OSHA
  • Management (4 years)
  • Commercial Claims (5 years)
  • Pricing
  • Research
  • Healthcare Management
  • Information security
  • Budgeting (4 years)
  • Litigation (6 years)
  • Documentation review
  • Customer relationship management
  • Personal injury law
  • Customer Service (17 years)
  • OSHA (6 years)
  • Conflict management
  • Data analytics
  • Workers' compensation law
  • Claims Processing (10 years)
  • Payroll (6 years)
  • Financial report interpretation
  • Office Management
  • Administrative Experience (6 years)
  • Medical Records (5 years)
  • Leadership
  • Strategic Planing
  • Insurance Verification (10 years)
  • Sales Experience (8 years)
  • Workers' compensation (8 years)
  • Supervising experience
  • Relationship management
  • Team management
  • Adobe Acrobat
  • Policy analysis
  • Insurance underwriting principles
  • Networking and relationship building
  • Claims handling

Timeline

Insurance Consultant

ICA Risk Management
11.2024 - Current

Chief Risk Manager & Claims Director

CFG Health Network
04.2024 - 10.2024

Risk Manager ARM

Jacob K. Javits Convention Center
03.2020 - 04.2024

Case Manager-Mental Health

Health First
06.2018 - 02.2020

Claims Manager/Examiner (Remote)

G4S Compliance & Investigations
11.2016 - 06.2018

Claims Case Manager/Examiner (Remote)

R.M.G Investigation
03.2015 - 11.2016

Claims Case CSR

State Farm Insurance
01.2013 - 03.2015

B.S. - Mechanical Engineering

Texas A & M - College Station

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