Anne Hill
Lynn,MA
Summary
Highly motivated individual with exceptional work ethic and outstanding research management capabilities. Demonstrated ability to collaborate with diverse groups and establish strong relationships. Quick to grasp new processes and excellent interpersonal skills, thriving in a team environment. Known for dedication, organization, and team orientation, with a high level of adaptability in fast-paced and evolving work settings.
Overview
24
24
years of professional experience
Work History
Assistant Vice President
Alpha Isle Services, LLC
05.2023 - Current
- Manage high-volume caseload, prioritizing tasks to ensure all claims are reviewed within five business days.
- Manage the monthly reserve scrub, analyzing and assessing potential claims and setting the appropriate reserve.
- Responsible for managing the funding of claims with the insurance carrier.
- Perform special projects as assigned by the Senior Vice President.
- Act as a resource to the senior claim auditors, claims auditors and administrative staff.
- Identify avenues for significant savings through cost containment measures, working with various vendors.
- Interact with Account Executives, keeping them advised of any ongoing claim issues.
Claims Manager
Rockport Benefits
10.2019 - 09.2022
- Responsible for adjudication of all stop loss claims, identifying significant savings adhering to a detailed and thorough claim review.
- Manage the claim department mailbox.
- Handle all phases of cost containment, including claim identification, vendor referral and follow up.
- Perform implementation calls for new business accounts.
- Analyzing each claimant, setting and monitoring the appropriate reserve.
Assistant Vice President
QBE North America
07.2018 - 10.2019
- Provide training and support to the claims analysts and administrative staff.
- Review and over sign all claims in excess of the analysts delegated authority level.
- Responsible for all claim inquires related to the captive product.
- Assist the Vice President of the claims department will special projects.
Senior Claims Analyst
TRU Services, A Liberty Mutual Insurance Company
05.2012 - 07.2018
- Adjudication of complex stop loss claims.
- Established productive relationships with external partners such as brokers, third party administrators and providers.
- Maintained up-to-date industry knowledge of industry trends and applied insights to enhance claims processing.
- Strengthened team performance by providing mentorship, guidance and training to claims analysts.
- Reviewed open renewals with the Underwriting team and provided feedback on outstanding claim issues.
Senior Stop Loss Claims Analyst
R.E. Moulton Inc. Aka American United Life Ins. Co
10.2004 - 10.2011
- Provide claim service to stop loss policy holders.
- Interacted with the sales department, keeping them advised of any concerns regarding TPA relationships.
- Review and over sign claims which exceeded the authority level established for claims analysts.
- Performed the SOX and MAR audits with management staff.
Senior Reinsurance Medical Claims Examiner
Northshore International Insurance Services
07.2000 - 06.2004
- Quantified and verified provider and hospital stop loss and HMO reinsurance claim data.
- Analyzed HCFA and UB-04 claim forms to ensure services rendered corresponded to claim payment summaries.
- Maximize underwriters revenue savings through identification of non-covered items and contractual limitations.
Education
High School Diploma -
Lynn English High School
Lynn, MASkills
- Decision making and accurate judgement
- Exceptional analytical ability
- Superior written and oral communication skills
- Plan Document and Stop Loss Policy interpretation and application of benefits
- Ability to handle a multitude of various demands and assignments
- Identification of third party liability claims
Timeline
Assistant Vice President
Alpha Isle Services, LLC
05.2023 - Current
Claims Manager
Rockport Benefits
10.2019 - 09.2022
Assistant Vice President
QBE North America
07.2018 - 10.2019
Senior Claims Analyst
TRU Services, A Liberty Mutual Insurance Company
05.2012 - 07.2018
Senior Stop Loss Claims Analyst
R.E. Moulton Inc. Aka American United Life Ins. Co
10.2004 - 10.2011
Senior Reinsurance Medical Claims Examiner
Northshore International Insurance Services
07.2000 - 06.2004
High School Diploma -
Lynn English High School
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