DIANE WILKERSON

• The Charlotte Market includes a 900-bed medical center, five community hospitals and 350 physician specialty practices
• This position required experience analyzing complex professional liability claims; reserving, reporting, and negotiating settlements of pre-suit claims; and managing defense strategy of litigated cases.
• Relevant skills include claims analysis, insurance coverage, negotiation expertise, mediation management, defense counsel collaboration.
• RESULTS
• Negotiated settlements with claimants, achieving fair outcomes while controlling costs.
• Conducted thorough investigations of complex claims, gathering evidence to support decision-making processes.
• Established strong relationships with external partners such as medical providers and legal professionals for efficient case management.

• 2010 joined Vertical Claims Management, a division of CCMSI, to audit professional liability claim reserves in North Carolina, New York and Florida
• 2011 subcontracted to North Carolina health care system as professional liability claims manager for two years
• 2013 assigned to monitor professional liability cases and recommend excess layer reserves for a health care system in New York
• 2015 team leader assigned to monitor ligated primary claims and recommend reserves for health care systems in New Jersey and Pennsylvania.
• 2018 supervised primary litigated cases and recommended defense strategy for a national healthcare system based in Tennessee with hospitals in New Mexico, Oklahoma, and Kansas.
• RESULTS
• Consistently met or exceeded key performance indicators in areas of customer satisfaction, cost containment, and claims resolution timeframes.
• Collaborated with legal counsel on high-profile cases, protecting company interests and minimizing financial losses.
• Managed high caseloads while maintaining excellent attention to detail throughout each claim's lifecycle from initial reporting to final settlement or litigation process.

• Consulted across the country with clients of Marsh Healthcare Practice who self-insured and self-administered their professional liability risks in captives and risk retention groups
• Analyzed current processes and procedures to recommend more efficient claims management practices
• Began a multiyear claims consulting project with the University of Miami Medical Group to hire staff, update their claims management process, make recommendations for a new data management system and audit claims for reserve adequacy.
• Transitioned to the Marsh Alternative Risk Solutions Practice which managed Joint Underwriting Associations in 5 states. This required an update of the Professional Standards for JUA claims management as well as a Claims Manual and Litigation Guidelines
• Managed claims for the Mississippi JUA, supervised claims for the West Virginia Boards of Risk and Insurance and the Missouri JUA
• From 2007 to 2010 performed claims management audits for a variety of clients as well as developed and completed three major Statements of Work for the University of Miami Medical Group including an RFP to hire additional defense firms.

• J P Bender & Associates was a third-party administrator in the Midwest, dedicated to servicing the claims management needs of self-insured and captive insured clients
• Collaborated with a software consulting firm to build a proprietary claims management database system which produced accurate loss runs for clients, brokers and excess carriers and supported coding of allegations, medical specialty, injury severity and trending of financials
• Managed professional and general liability claims for clients and presented high level reports of serious claims and data trends at Captive Board meetings.

RESULT

This TPA formed business relationships with a well-known actuarial firm and a large healthcare law firm which resulted in five large healthcare TPA clients that self-insured their professional liability risks. As a result, this TPA enjoyed several decades of successful operation including collaboration with the offshore captive management. world.