Mark Caron
Pascoag,Rhode Island
Summary
Results-driven Associate Director with extensive experience in claims management, process improvement, and quality assurance. Proven ability to develop policies and lead diverse teams to achieve operational excellence.
Overview
32
32
years of professional experience
Work History
Associate Director – BPO, Process Delivery and Transition Manager
NTT Data Services
Canton, USA
01.2013 - Current
- Company Overview: Third-party administrator for Harvard Pilgrim Healthcare, Tufts, and Point32 Health.
- Managing departments in the Insurance Liability and Recovery teams, Quality Assurance, and the Training/Documentation teams.
- Establish and implement departmental policies, goals, objectives, and procedures, based on business needs and rules for implementation of claims.
- Determine staffing requirements, and interview, hire and train new employees, or oversee those personnel processes.
- Project management experience including coordinating project activity on new claims processes.
- Approve, publish, and deliver all new claims documentation for process improvement, interpret organizational goals, policies, and procedures, including developing requirements.
- Meet with department heads, managers, supervisors, vendors, and others, to solicit cooperation and resolve escalations.
- Direct daily operations of department, analyzing workflow, establishing priorities, developing standards, and setting deadlines.
- Managed Staff of Business Analyst, ILR Claim Associates, QA and Training and Documentation teams.
- Developed technical solutions to business problems, defining, analyzing, and documenting requirements to ensure staff is managing claims in accordance to established guidelines and/or special account instructions.
- Third-party administrator for Harvard Pilgrim Healthcare, Tufts, and Point32 Health.
Account Manager / Director of Client Services
Sedgwick CMS
Hartford, USA
04.2011 - 01.2013
- Company Overview: Third party Administrator.
- Gather and organize all monthly reporting requirements as needed by client.
- Resolved all major client/broker/carrier customer service issues regarding audit results, vendor utilization, and field claim office training issues for process improvement.
- Developed and drafted all service level requirements for claims special handling requests from client.
- Coordinated all services between agent/broker/carrier to TPA.
- Acted as single point of contact for clients/brokers and agents.
- Delivered results to Carriers as needed on accounts.
- Ensured compliance with all applicable quality initiatives and claim audits.
- Gathered all reporting and summarized all metrics data for clients and internal review to assure that all Service Level Agreements are satisfied.
- Participated in client renewals and RFP presentations from a TPA perspective.
- Third party Administrator.
Commercial Supervisor
Sedgwick CMS
05.2008 - 04.2011
- Company Overview: Third party Administrator.
- Managed claim staff with various experience levels handling commercial auto, commercial general liability, professional liability, workman’s compensation claims.
- Provided Direction and leadership to claim associates to achieve corporate service goals and best practices.
- Provided reserving and litigation management of all complexes, high exposure claims.
- Provided financial authority on settlement amounts of large exposure claims, including determination of coverage, investigation, negotiation, and settlement of claims.
- Provided overall claims management including complex and high exposure direction, litigation management, special investigative handling, reserving, negotiation, and settlement guidance.
- Third party Administrator.
Senior Casualty Claims Supervisor
MAPFRE-Commerce Insurance Company
Webster, USA
02.2003 - 05.2008
- Claims supervisor responsible for completing all employee performance appraisals, including coaching, mentoring, counseling, and training casualty claim staff associates.
- Provide direction to associates based on level of expertise and experience in claim handling.
- Provided overall claims management including litigation management, special investigative handling, reserving, negotiation, and settlement guidance.
- Provided utmost customer service to our internal and external customers.
Special Investigative Unit Supervisor (SIU)
MAPFRE-Commerce Insurance Company
11.2000 - 02.2003
- Supervised staff of SIU adjusters performing investigations on suspect Auto Bodily Injury claims.
- Contributor to the development of Express SIU claims handling to increase satisfaction of policy holders.
Casualty Adjuster / Field Adjuster
MAPFRE-Commerce Insurance Company
11.1993 - 11.2000
- Extensive field work investigating and gathering information for complex personal auto liability claims.
- Performed in depth investigations, including coverage analysis and litigation management.
- Conducted in person contact with claimants, attorneys, and other investigative personnel to resolve all liability and coverage issues.
- Negotiated large loss settlements.
- Participated and represented company at Arbitration Hearings.
- Participated in peer training programs.
Education
A.S. - Business Administration
Quinsigamond Community COLLEGE
WORCESTER, MA05.1999
A.S. - Criminal Justice
Tunxis Community COLLEGE
FARMINGTON, CT05.1993
Skills
- Certified Arbitrator
- Claims management
- Process improvement
- Project management
- Quality assurance
- Recruiting and interviewing
- Coaching and mentoring
- Staff development
- FCLA
- CCLA
- SCLA
- AIC 33 course completion
Timeline
Associate Director – BPO, Process Delivery and Transition Manager
NTT Data Services
01.2013 - Current
Account Manager / Director of Client Services
Sedgwick CMS
04.2011 - 01.2013
Commercial Supervisor
Sedgwick CMS
05.2008 - 04.2011
Senior Casualty Claims Supervisor
MAPFRE-Commerce Insurance Company
02.2003 - 05.2008
Special Investigative Unit Supervisor (SIU)
MAPFRE-Commerce Insurance Company
11.2000 - 02.2003
Casualty Adjuster / Field Adjuster
MAPFRE-Commerce Insurance Company
11.1993 - 11.2000
A.S. - Business Administration
Quinsigamond Community COLLEGE
A.S. - Criminal Justice
Tunxis Community COLLEGE
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