Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Interests
Languages
Timeline
c7

Andrew Jenkins

Chicago,IL

Summary

Enthusiastic Complex Claims Specialist examines claims, negotiates and processes settlements and verifies insurance coverage. Attentive team player consistently treats clients fairly and equitably. Motivated to succeed in fast-paced and deadline-driven professional environment. Seeks to further claims career while expanding skills in data analytics and project management to lay the groundwork for a transition into corporate and healthcare compliance.


Overview

22
22
years of professional experience
1
1
Certification

Work History

Complex Claims Specialist – Healthcare

CNA
12.2022 - Current
  • Handle professional liability claims for Allied Health Provider and Dentist & Oral Surgeon policies.
  • Provide excellent customer service to CNA Insureds by empathizing with their distress and guiding them through the claims and litigation processes.
  • Respond to Insureds' concerns and report claim developments timely.
  • Manage and resolve hundreds of claims of various degrees of complexity and severity: current pending is 120 from across the country. Demands have ranged from $5,000 to $3.95M.
  • Discuss claim valuation with claims handlers, leadership, and underwriting to ensure accurate reserving.
  • Draft and issue Reservation of Rights and Declination of Coverage letters detailing the policy provisions underlying these determinations.
  • Negotiate direct resolutions with claimants or their attorneys.
  • Lead over a dozen mediations, several of them with multiple parties.
  • Work closely with law partners to assess and resolve claims.
  • Coordinate with adjusters from other carriers to defend shared Insureds or reach joint agreements for separate co-defendants.
  • Learn and apply multiple versions of AHP and Dentist and Oral Surgeons occurrence and claims made policies.
  • Respond to claims notices within 24 hours of receipt.
  • Develop a basic understanding of dentistry.
  • Persuade hundreds of dentists, but admittedly not all, to consent to settlement of their claims.
  • Explain the potential ramifications of reporting settlements to the National Practitioner Data Bank.
  • Participate in multiple employee resource groups.
  • Provide continued guidance for claims representatives.

Claims Representative, Initial Solutions Team, AHP and Dental Professional Liability

CNA
04.2021 - 11.2022
  • Provide excellent customer service to CNA Insureds throughout the claims process.
  • Review hundreds insurance and claims documents to verify required information and secure any missing data.
  • Explain the Dental or AHP policy to Insureds, especially coverage extensions and exclusions.
  • Issue Reservation of Rights and Declination of Coverage letters detailing the policy provisions underlying these determinations.
  • Timely resolve non-claims: potential claims, subpoena assistance, Dental Board investigations, ethics and legal questions, and more.
  • Respond to claims notices within 24 hours of receipt.
  • Open and assess 4-5 new files a week.
  • Manage First Aid Supplement and Medical Expense payments.
  • Work to resolve claims up to $50,000 and gather information to support settlement negotiations.
  • Coordinate with internal and external legal counsel to resolve claims, subpoenas, and Board matters.
  • Work with Legal Services to manage billing requirements and counsel expectations.
  • Consult with other adjusters, Risk Control and leadership to find solutions to novel questions.
  • Worked productively in fast-moving work environment to process large volumes of claims.

Claims Representative, Initial Solutions Team, Accountants Professional Liability

CNA
06.2018 - 03.2021
  • Provide excellent customer service to CNA Insureds throughout the claims process.
  • Manage expert expenses by keeping engagements focused and thoroughly explaining our specific needs.
  • Open, process, and resolve hundreds of Accountants Professional Liability claims, sometimes receiving 4-5 a week.
  • Respond to claims notices within 24 hours of receipt.
  • Negotiate settlements with claimants or their attorneys.
  • Work with underwriters, Risk Control, other adjusters, and leadership to address concerns about claims, coverage, policies, file handling, and other issues.
  • Draft coverage letters for all files.
  • Work with Legal Services to ensure proper legal billing and manage legal expenses.
  • Serve as a Buddy for 2 new team members.

Paralegal Compliance, Legal Services Department

CNA
06.2006 - 05.2018
  • Review appeals of adjustments to hundreds of legal bills and determine law firm compliance with billing guidelines. Notify firms of compliance issues. Assess and approve or deny appeals of adjustments.
  • Twice redesign the appeals process, once from paper to fully digital and again from a legacy system to SharePoint.
  • Participate in National Vendor Expense Management Team to assess retention of preferred vendors.
  • Coordinate legal bill reviews with a team of 7 senior attorneys.
  • Train and manage additional 2 appeals staff members.
  • Review, audit, and adjust hundreds of legal bills.
  • Manage customer expectations to reduce disagreements while exercising fair judgment of disputed items.
  • Enter invoices into an invoice and appeals tracking database and maintain the appeals section.
  • Extensive use of claim management software, bill review software, and Microsoft Office Suite.
  • Participate in transition between billing systems.
  • Perform Westlaw legal research as needed.
  • Manage file storage on a shared network to facilitate team cooperation between multiple branch offices.

Data Entry Specialist, Accounts Payable

CNA
05.2003 - 05.2006
  • Completed data entry tasks with accuracy and efficiency.
  • Corrected data entry errors to prevent later issues such as duplication or data degradation.

Education

J.D. - Compliance

Loyola University of Chicago
Chicago, IL
05-2022

Skills

  • Settlement determinations
  • Coverage assessments
  • Negotiation leadership
  • Complex claims consulting
  • Liability denials
  • Claims investigation
  • Policy interpretation
  • Microsoft office
  • Verbal communication

Accomplishments

    Resolved hundreds of claims by direct negotiation with claimants or their attorneys.

    Resolved dozens of other claims in collaboration with defense counsel.

    Mediated 15 claims: 10 settled the same day, 3 settled within 2 weeks, 2 did not settle due to lack of Insured's consent, 1 did not settle because the parties were too far apart.

    Worked with Risk Control to help Insureds actively minimize risk by using proper engagement letters, consent forms, and patient termination procedures.

    Twice redesigned the legal billing appeals process, first from paper to digital and later from a legacy Access database to SharePoint.

Certification

Texas adjuster license

Certified in Healthcare Compliance

Member IL Bar

Interests

  • Traveling the world to experience different cultures, watch wild animals, and see wondrous things
  • Exploring famous landmarks, historical sites, and cultural attractions in a new destination
  • Sharing travel tips, recommendations, and insights with fellow enthusiasts
  • Experience live music locally and abroad
  • Listen to records with friends
  • Read books of all sorts to expand my horizons

Languages

English
Native or Bilingual

Timeline

Complex Claims Specialist – Healthcare

CNA
12.2022 - Current

Claims Representative, Initial Solutions Team, AHP and Dental Professional Liability

CNA
04.2021 - 11.2022

Claims Representative, Initial Solutions Team, Accountants Professional Liability

CNA
06.2018 - 03.2021

Paralegal Compliance, Legal Services Department

CNA
06.2006 - 05.2018

Data Entry Specialist, Accounts Payable

CNA
05.2003 - 05.2006

J.D. - Compliance

Loyola University of Chicago

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