GREG MAKOZY
Aliquippa
Summary
Accomplished Claims Management Professional with 7 years of experience in claims operations and leadership. Specializes in claims investigation, risk assessment, policy interpretation, and regulatory compliance. Proven ability to manage high-volume caseloads and mitigate financial exposure while fostering strong relationships with clients and vendors.
Overview
8
8
years of professional experience
Work History
Claim Manager
RTA Cabinet Store
Remote
05.2022 - Current
- Managed all high dollar claim cases over $15k, reviewed all claim team denial's and managed all claim escalations for customer's and Trade Pro's on a week to week basis
- Managed high dollar claim cases over $15k, reviewed claim team denials, and handled claim escalations for customers and Trade Pros weekly
- Analyze claim trends and financial exposure to identify root causes and recommend cost-containment strategies to leadership to reduce replacement costs through partial refunds
- Developed and implemented claim forms, automated decision notifications, and conducted monthly shipping audits to reduce shipping-related claim errors and escalations
- Developed and implemented new claim forms, automated decision notifications, and monthly shipping audits, reducing shipping-related claim errors and escalations by double-digit percentages
- Implemented process improvements and standard operating procedures to streamline claim handling and enhance consistency with shipping claims
- Revised and reworked RTA claim/warranty policies to reduce customer escalations with the goal to build a stronger partnership with our Trade Pro's
- Maintain compliance with company policies and applicable regulations while mentoring my team/staff on best practices and quality claim standards
Claim Analyst
Beemac Trucking
Ambridge, PA
05.2020 - 05.2022
- Developed and maintained loss files, input new loss records into Risk module, and monitored charge-backs while ensuring compliance with DOT reportable accident regulations
- Filed accurate and timely letters/reports with claimants and/or their insurance companies, then ensured Beemac collects the proper payments from parties whose negligent behavior resulted in losses for the company
- Managed Beemac’s insurance policies, deductibles, and premiums for accident, injury, and cargo coverages
- Attended monthly safety meetings, providing data reports on accident, physical damage, and cargo claims to executive team for informed decision-making
- Managed insurance policies, deductibles, and premiums for accident, injury, and cargo coverages, ensuring adequate protection and compliance for Beemac
Claim Analyst
Cigna
Robinson, PA
01.2019 - 05.2020
- Managed an assigned caseload of 150 complex Short Term Disability cases and State Disability claims
- Led team at Caesar’s Entertainment in tracking weekly metrics for decision time on new claims, mail, compliance, and reporting on team goals.
- Evaluated customer eligibility through 25 employer contracts with each contract having differing policy structure's
- Collaborated with customers, employers, clients, physicians, and attorneys to ensure effective management of claims.
- Coordinated with customers and physicians to medically manage claims through daily reviews of medical information in staffing meetings.
- Support and promote all integration initiatives including FMLA, Life Assistance Programs, Integrated Personal Health Team, Your Health First and Healthcare Connect
- Adhered to Cigna Group Operations and Corporate Compliance, Policies and Procedures
Education
Bachelor - Business Management
John Carroll University
Cleveland, Ohio05-2016
Skills
- Claims analysis
- Claims investigation
- Claims auditing
- Policy interpretation
- Regulatory compliance
- Risk assessment
- Attention to detail
- Time management
Timeline
Claim Manager
RTA Cabinet Store
05.2022 - Current
Claim Analyst
Beemac Trucking
05.2020 - 05.2022
Claim Analyst
Cigna
01.2019 - 05.2020
Bachelor - Business Management
John Carroll University