Mary Karabetsos
Three Rivers
Summary
Dynamic Senior Claims Examiner with extensive experience at MCCA, skilled in executing comprehensive investigations and ensuring adherence to Michigan No-fault Law, eager to take on new challenges.
Overview
16
16
years of professional experience
Work History
Senior Claims Examiner
MCCA
Livonia
08.2018 - Current
- Conducts thorough investigations by gathering relevant documentation to complete initial audits of claims submitted to MCCA by its member companies.
- Developed training materials for new claims staff and ongoing education.
- Analyzed trends in claim submissions to identify potential risks.
- Maintained detailed records of all activities associated with each case file.
- Review and analyze complex insurance claims for accuracy, validity, and compliance with the member policy terms. Ensure claims are paid in accordance with Michigan's No-Fault Law.
- Reviews and approves requests for reimbursements on complex Michigan PIP claim files from member carriers.
- Maintains detailed and accurate records of claims, review, and decisions.
- Determines reserve amounts to ensure that MCCA has sufficient funds to pay for any claims that arise, while also maintaining financial stability.
- Collaborate with legal counsel to assess any coverage concerns, and to assist with the resolution of disputed claims.
- Provide guidance to member companies with compliance with MCCA claims policies and procedures.
- Stay up to date and informed about Michigan's No-Fault Law.
- It is a key resource and conducts training for member companies regarding the provisions of the Michigan No-Fault Law.
- Assist in training new employees.
- Attends and participates in Claim Committee meetings and roundtable discussions.
Large Loss Senior Claims Specialist
State Farm
Kalamazoo
01.2010 - 08.2018
- Investigated large loss claims.
- Processed payments accurately and efficiently according to established guidelines.
- Maintained detailed records of all claims activities in the database system.
- Analyzed data to identify trends and improve claims processing efficiency.
- Reviewed and verified customer information to ensure accuracy of claims.
- Created reports detailing the status of outstanding claims for management review.
- Resolved customer inquiries in a timely manner, while maintaining high levels of customer service.
- Maintained an up-to-date knowledge of industry standards and best practices related to insurance claims processing.
- Collaborated with other departments to streamline processes and improve overall efficiency.
- Reviewed medical records for accuracy and completeness according to established guidelines.
- Analyzed claim trends and patterns to identify potential fraud or abuse.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Coordinated and planned investigations of claims to confirm compensability and coverage.
Education
Masters of Arts - Family Life Education
Western Michigan University
Kalamazoo, MI12.2002
Bachelor of Science - Sociology
Western Michigan University
Kalamazoo, MI04.2001
Skills
- Microsoft Office Suite
- Google Workspaces
- Microsoft Teams
- Zoom
- Google Meet
- Gmail
- Yahoo
- Outlook
- Adobe Creative Suite
- Customer service
- Active listening
- Positive attitude
- Problem solving
- Analytical skills
- Critical thinking
- Relationship building
- Legal collaboration
- Reserve determination
- Effective communication
- Coverage evaluation
- Investigative skills
- Interpersonal communication
- Adaptability and flexibility
- Organizational skills
Work Email
Mkarabetsos@micatastrophic.com
Personal Email
mc3272@yahoo.com
Timeline
Senior Claims Examiner
MCCA
08.2018 - Current
Large Loss Senior Claims Specialist
State Farm
01.2010 - 08.2018
Masters of Arts - Family Life Education
Western Michigan University
Bachelor of Science - Sociology
Western Michigan University