Katherine Lie
Anchorage,AK
Summary
Highly skilled Senior Claims Examiner with sound knowledge of claims management processes and regulatory compliance. Strengths include thorough investigation, accurate claim assessment, and negotiation skills which have led to successful resolutions in past roles. Well-versed in managing complex cases, handling multiple tasks concurrently, and contributing positively to team objectives.
Energetic and enthusiastic insurance professional motivated to succeed in fast-paced and deadline-driven professional environment.
Overview
8
8
years of professional experience
2012
2012
years of post-secondary education
Work History
Senior Claim Examiner
ESIS
Scranton, PA
06.2024 - Current
- Evaluated complex insurance claims for accuracy and compliance with company policies.
- Collaborated with adjusters to facilitate timely claim resolutions and gather necessary documentation.
- Reviewed medical records and accident reports to assess claim validity and determine eligibility.
- Prepared detailed reports summarizing claim findings for internal review and audit purposes.
- Negotiated settlements with claimants or their representatives in order to reach an equitable resolution.
Sr Resolution Manager
Wilton Adjustment Service
Anchorage, United States
07.2022 - 06.2024
- Led a team of resolution specialists in investigating and resolving complex customer issues promptly and efficiently
- Implemented new processes and procedures to streamline resolution workflows, resulting in a 20% reduction in response times
- Collaborated with cross-functional teams to identify root causes of customer complaints and develop strategic solutions to prevent future issues
- Conducted regular performance reviews and provided ongoing training and coaching to team members to enhance productivity and customer satisfaction
- Investigated complex and litigated claims from inception to conclusion
- Obtained recorded statements for AOE/COE and SIU claims
- Coordinated benefit payments and vendor referrals
- Investigated and pursued subrogation potential
- Conducted file reviews with clients and brokers
- Facilitated implementation of EDI for Medicare, FROI transmissions, and medical bills
- Managed Discovery and worked with the Attorney General's Office
- Prepared and submitted legal documents, attended prehearings, mediations, and depositions
- Conducted claim audits and quality reviews
- Handled prior TPA takeover claims and facilitated settlement negotiations
- Coordinated structured annuities during settlement.
- Facilitated communication between clients and internal departments for issue resolution.
Senior Claims Examiner
Penser North America
Anchorage, United States
07.2017 - 03.2022
- Reviewed and analyzed insurance claims to determine coverage, liability, and potential fraud, ensuring accurate and timely claim resolutions
- Conducted thorough investigations into claim discrepancies, including interviewing claimants and gathering supporting documentation, to secure fair and equitable claim settlements
- Collaborated with internal departments and external stakeholders to gather pertinent information and reach consensus on claim resolutions
- Implemented process improvements to streamline claim adjudication, resulting in increased efficiency and customer satisfaction
- Investigated complex and litigated claims from inception to conclusion for State of Alaska Risk Management
- Obtained recorded statements for AOE/COE and SIU claims
- Coordinated benefit payments and vendor referrals
- Investigated and pursued subrogation potential
- Conducted file reviews with clients and brokers
- Facilitated implementation for EDI on Medicare, EDI FROI transmissions, and medical bills
- Conducted Discovery and worked with Attorney General Office
- Prepared and submitted legal documents
- Attended prehearings
- Conducted claim audits and quality reviews
- Assumed and handled prior TPA takeover claims.
Education
White Oak High School
White Oak, TXSome College (No Degree) - Social Psychology
Kilgore College
Kilgore, TXSkills
- Conflict resolution
- Negotiation skills
- Fraud investigation
- Compliance evaluation
- Customer relationship management
- Policy interpretation
- Litigation management
- Liability and coverage
- Claims processing
- Legal documentation and reporting
- Legal proceedings
Timeline
Senior Claim Examiner
ESIS
06.2024 - Current
Sr Resolution Manager
Wilton Adjustment Service
07.2022 - 06.2024
Senior Claims Examiner
Penser North America
07.2017 - 03.2022
White Oak High School
Some College (No Degree) - Social Psychology
Kilgore College