Summary
Overview
Work History
Education
Skills
Certification
TEACHING EXPERIENCE
Websites
References
Timeline
Generic

CANDACE REESE

ARLINGTON,TX

Summary

Dynamic Examiner in Charge with extensive experience in regulatory compliance at Lewis and Ellis, LLC. Proficient in analyzing data and writing reports, with a strong focus on identifying market discrepancies and ensuring documentation accuracy. Demonstrated ability to drive timely resolutions in claims processing through effective collaboration and organizational skills. Expertise in TeamMate+, Office Suite, and advanced Excel functions.

Overview

21
21
years of professional experience
1
1
Certification

Work History

Market Conduct Examiner

Lewis and Ellis, LLC
Plano, TX
06.2024 - Current
  • Led team of examiners for PBM market conduct examination, maintaining thorough work papers and drafting comprehensive reports.
  • Investigated discrepancies in third-party documentation to ensure accuracy and compliance.
  • Monitored claims life cycle to secure timely resolutions and improve processing efficiency.
  • Compiled evidence from medical records, employment histories, and legal documents to support claims assessment.
  • Recommended actions based on review findings, including benefit approvals or denials.
  • Identified potential fraud through data analysis, detecting irregularities and discrepancies.
  • Determined claim validity according to established rules and regulations.
  • Conducted quality assurance reviews on completed claims to verify documentation accuracy.

Market Conduct Examiner

Regulatory Insurance Services
Dover, De
06.2004 - 12.2012
  • Identify concerns in the marketplace by reviewing Market Conduct Annual Statement data, complaints, form and rate filings, class action lawsuits, NAIC bulletin boards, etc.
  • Participate in all phases of market conduct analysis and investigations, including the review of insurance company practices relating to underwriting and rating, sales, and advertising, claims practices, policy provisions and complaint handling.
  • Draft and send interrogatories and request relevant documents from the company.
  • Obtain, review, and evaluate data received from insurance companies, ensuring the accuracy and integrity of data while looking for indicators of errors and trends.
  • Complete work timely, accurately, and in accordance with the Market Regulation Handbook.

Education

Master of Science - Mental Health and Behavioral Counseling

University of North Texas
Denton, TX
12-2027

Bachelor of Science - Education in Human Services

University of Tennessee
Knoxville, Tennessee

Skills

Organizational skills

  • Flexibility and adaptability
  • Team collaboration
  • Compliance expertise
  • Written and oral communication
  • Management proficiency
  • Examination software proficiency
  • Microsoft Office Suite
  • Adobe Acrobat expertise
  • Knowledge of NAIC standards
  • Confidentiality practices
  • Regulatory compliance
  • Report writing
  • Interpersonal communication
  • Records management
  • Claims processing
  • Documentation accuracy

Certification

  • Insurance Examiner Certification
  • Accredited Insurance Examiner (AIE)
  • Market Conduct Management (MCM)
  • Teaching Certification
  • Generalist (EC - 6)
  • English as a Second Language Supplemental

TEACHING EXPERIENCE

  • Adams Elementary School – Arlington, TX
  • 4th Grade Math/Science Teacher
  • Mentor Teacher that blends modeling, coaching, instructing, collaborating, and encouraging new teachers to build competency in program standards as well as support peers in developing the skills and knowledge to meet the teaching standards.
  • Lee Elementary School – Irving, TX
  • 4th Grade ELAR/ 2nd Grade Self-Contained Teacher
  • Design and deliver rigorous, engaging and standards-based curriculum while featuring a safe, creative, and empowering learning environment comprising a diverse population of 25-28 students.
  • Leverage achievement-based and progress-based assessments to identify students with unique needs and implement data-driven learning differentiation to accommodate students of all abilities.
  • Coordinate educational fieldtrips and other diverse enrichment opportunities to augment student learning.
  • Develop and integrate strategies core competencies, inspire culture of curiosity self-excellence, and appreciation for learning.
  • Trimmier Elementary School – Killeen, TX
  • 4th Grade Self-Contained/Kindergarten Teacher
  • Prepare and implement unique and personally developed lessons to classrooms averaging 20-25 students.
  • Developed math and literacy curriculum and testing methods for students and tutored four separate struggling students to reach age-level averages in these subjects.
  • David Daniels Elementary School – Grand Prairie, TX
  • 4th Grade Departmentalized (Writing) Teacher
  • Administered and developed subject specific assessments for the purpose of assessing student competency levels and/or developing individual learning plans for three classes of 25-28 students.
  • Advised parents and/or legal guardians of student progress for the purpose of communicating expectations; student’s achievements; developing methods for improvement and/or reinforcing classroom goals in the home environment.
  • Collaborated with instructional staff, other school personnel, parents, and a variety of community resources for improving the overall quality of student outcomes, achieving established classroom objectives in support of the school improvement plan.
  • Fairmeadows Elementary School –Duncanville, TX
  • 4th Grade Self-Contained/Departmentalized (Math) Teacher
  • Increased growth by improving students’ content knowledge, procedural skills, and application skills for three classes of 25-28 students.
  • Developed lesson plans that reinforced math skills and connected the classroom with the real world.
  • Promoted proper classroom etiquette through Positive Behavior Interventions and Supports (PBIS).
  • 4th graders received the best math scores of the entire district on their Benchmark and 4th graders received the highest writing score on their State of Texas Assessments of Academic Readiness (STAAR) in the district.
  • Mansfield Independent School District - Mansfield, TX
  • Substitute Teacher
  • Implement lesson plans for the class to which they are assigned.
  • Manage classroom behavior.
  • Create reports to inform the students' permanent teacher of their success.
  • Maintain normal classroom routines and discipline procedures.

References

References available upon request.

Timeline

Market Conduct Examiner

Lewis and Ellis, LLC
06.2024 - Current

Market Conduct Examiner

Regulatory Insurance Services
06.2004 - 12.2012

Master of Science - Mental Health and Behavioral Counseling

University of North Texas

Bachelor of Science - Education in Human Services

University of Tennessee
CANDACE REESE