Risk management professional with strategic mindset and solid foundation in identifying and mitigating risks. Known for delivering impactful risk-reduction strategies that safeguard organizational integrity. Emphasizes collaboration and adaptability, ensuring teams are aligned with changing objectives and goals. Skilled in regulatory compliance, risk assessment, and crisis management. Outstanding leadership qualities proven in work history performance and outcomes with excellent communication skills.
Overview
41
41
years of professional experience
Work History
Director of Risk/Claims Management
Paragon Management SNF LLC
06.2005 - Current
Advise on risk management and prevent and manage risk at 11 skilled nursing facilities and Paragon Jets, while managing a team of risk professionals, providing guidance and support in their daily activities
Oversee liability Captive Program for all litigated cases; provide timely insights into emerging risks and opportunities based on market trends analysis; ensure compliance with regulatory requirements by conducting regular audits and implementing necessary corrective actions. Participates in professional liability mediations.
Oversee and manage all EPLI and WC claims, policies and procedures.
Develop risk management programs for all lines.
Prevent risk by developing and facilitating proactive risk management workshops for employees at various levels, implementing comprehensive risk management frameworks and policies, promoting transparency and accountability across all departments and implementing robust business continuity plans to minimize disruptions during crisis situations
Enhance risk mitigation strategies through continuous monitoring and assessment of potential threats, maintaining open lines of communication with regulators and ensuring ongoing alignment with evolving compliance requirements
Optimize insurance coverage by negotiating favorable terms with brokers, reducing premium costs without compromising protection levels
Provide independent oversight to operational risk by applying subject matter expertise and industry knowledge to management activities, and contributing to overall organizational resilience through active participation in industry forums, staying current on best practices in risk management
Collaborated with attorneys to develop winning strategies for medical malpractice and professional liability cases.
Educated colleagues and other professionals on medical malpractice investigation best practices through presentations at conferences and workshops.
Established positive relationships with customers and other staff members.
Claims Manager
Kemper Insurance Companies
06.2001 - 06.2005
Assessed and managed claims from investigation through remediation, and reduced company exposure by implementing risk mitigation practices for various industries, including manufacturing and pharmaceutical, while managing a team of adjusters, providing coaching and performance feedback for improved productivity
Implemented quality assurance measures, monitoring staff performance and providing constructive feedback for continuous improvement efforts.
Managed a team of adjusters, providing coaching and performance feedback for improved productivity.
Implemented quality assurance measures by monitoring staff performance and providing constructive feedback for continuous improvement efforts; reduced claim disputes by enforcing strict adherence to policy terms and conditions; coordinated catastrophe response efforts, ensuring prompt deployment of resources during high-volume periods or natural disasters; developed training materials to ensure consistent handling of claims across the department
Skilled at working independently and collaboratively in a team environment.
Worked well in a team setting, providing support and guidance.
Claims Manager
Gallagher Bassett Services Inc.
08.1995 - 06.2001
Managed claims for various industries, including hotels and airlines, at a high level, including claim audits; while maintaining compliance with industry regulations at all stages of the claim process and overseeing a team of adjusters
Conducted thorough investigations of complex claims, gathering evidence to support decision-making processes; documented and communicated timely claims information while supporting accurate outcomes; identified insurance coverage limitations with thorough examinations of claims documentation and related records; coordinated catastrophe response efforts, ensuring prompt deployment of resources during high-volume periods or natural disasters; streamlined communication between adjusters and clients, expediting claim resolution times; enhanced customer satisfaction with timely and accurate claims resolutions
Collaborated with other departments to improve overall organizational effectiveness in addressing client needs.
Streamlined communication between adjusters and clients, expediting claim resolution times.
Oversaw regular audits of claim files ensuring accuracy in reserve amounts and adherence to established guidelines; negotiated settlements with claimants, achieving fair outcomes while controlling costs; identified suspicious losses and contacted manager for investigative assistance; worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial
Implemented quality assurance measures, monitoring staff performance and providing constructive feedback for continuous improvement efforts; managed a team of adjusters, providing coaching and performance feedback for improved productivity; developed training materials to ensure consistent handling of claims across the department; improved claims processing efficiency by implementing streamlined workflow procedures
Claims Litigation Specialist
Royal Insurance
05.1984 - 08.1992
Investigated claims and managed high volume caseload while working with attorneys throughout litigation
Conducted thorough investigations of claims, gathering critical evidence to support case resolution; identified potential risks or weaknesses in cases early on allowing proactive strategizing towards optimal resolution; streamlined litigation processes for improved efficiency and cost effectiveness; achieved favorable outcomes in complex cases through meticulous research and analysis; developed strong working relationships with opposing counsel for effective communication and negotiation throughout the litigation process; enhanced client satisfaction by addressing concerns promptly and providing regular updates on case progress; reduced case backlog by efficiently prioritizing and managing high-volume caseloads; improved team collaboration through clear communication regarding shared tasks and responsibilities
Improved team collaboration through clear communication regarding shared tasks and responsibilities.
Streamlined litigation processes for improved efficiency and cost effectiveness.
Education
High School Diploma -
John H Glenn
Elwood, NY
Skills
Legal Compliance Monitoring
Team leadership
Claims analysis
Problem-Solving
Staff management
Risk management
Organizational Skills
Decision-Making Skills
Client Relationship Management
Risk mitigation strategies
Teamwork and collaboration
Training
Human Resources Knowledge
Operational risk management
Claims auditing
Timeline
Director of Risk/Claims Management
Paragon Management SNF LLC
06.2005 - Current
Claims Manager
Kemper Insurance Companies
06.2001 - 06.2005
Claims Manager
Gallagher Bassett Services Inc.
08.1995 - 06.2001
Claims Litigation Specialist
Royal Insurance
05.1984 - 08.1992
High School Diploma -
John H Glenn
Similar Profiles
JAQUEL A. MOOREJAQUEL A. MOORE
Maintenance Worker at Paragon Management LLCMaintenance Worker at Paragon Management LLC