Michael Ashworth, RN, BSN, AIC, MBA
Dayton,OH
Summary
Experienced claims professional with 30+ experience in Workers Compensation Claims Supervision, in multiple jurisdictions. Experience working with highly diverse group of staff and maintaining strong relationships with all levels the organization. Strong understanding of the claims process. Additional experience as an Occupational Health RN and Health & Welfare Benefits Manager.
Overview
32
32
years of professional experience
1
1
Certification
Work History
Cost-Mitigation Specialist
Verisk
09.2023 - 01.2024
- Review completed 2-3 Medicare Set-Asides for potential costs savings reaching out to providers to clarify future medical costs for Medicare / CMS submission
- Review update medical & updated provider submissions for additional cost mitigation opportunities.
- Worked closely with adjusters, paralegals, attorney's, excess carriers, and other internal / external customers.
Medical Analyst - MSA
Verisk
03.2023 - 09.2023
- Review and summarize medical records to develop allocations for future medical costs Medicare Set-Asides for settlement of Workers Compensation and other liability claims, completing 2-3 files per day.
- Remain familiar with CMS guidelines & updates for the development of allocations
- Work closely with other team members (legal, sales, etc.) to ensure clients files are handled professionally and expediently
Supervisor Workers' Compensation Claims
The Cincinnati Insurance Companies
07.2016 - 03.2023
- Manage & supervise complex / high-dollar claims handled by Field Claims Associates on all matters in multiple claims jurisdictions including Illinois, Ohio, Minnesota, Wisconsin, Kansas, Arkansas, Iowa, Michigan, Indiana, California, and Nebraska,
- Provide technical direction, supervision, and support to Field Claims associates.
- Analyze & maintain appropriate reserves for cost-exposure, both expected & unexpected, for the life of the claim.
- Work closely with & provider direction to defense counsel.
Case Manager II
The Cincinnati Insurance Companies
11.2014 - 07.2016
- Decreased case management vendors from > 150 to < 20
- Provide clinical support for file claim handlers and headquarters staff ensuring optimal case management utilization
- Communicate with case management vendors and coordinates referrals
- Provide oversight & medical guidance for catastrophic and
Telephonic Nurse Case Manager
WorkStar Health Services
12.2011 - 10.2014
- Medical claims management for Ohio State Fund Employers
- Day to day medical case management of W/C Claims
- Work with injured workers, TPA, Employers and the Ohio BWC facilitating medical care needs of injured workers and return to work
- Maintain detailed knowledge of the Ohio BWC system and jurisdictional requirements.
Workers' Compensation Program Manager
Premier Health Partners
06.2008 - 02.2011
- Administered multiple self-insured Workers' Compensation risks for multi-hospital health system, while maintaining a full claims management case load
- Acted as a W/C consultant for Hospital System employees by training management and employees of affiliate.
- Developed detailed plans based on broad guidance and direction.
- Engaged and worked alongside cross-functional stakeholders to manage strategic initiatives.
- Managed and supervised administrative and daily program operations, complying with policies and regulations.
Employee Benefits Manager - Health & Welfare
Premier Health Partners
06.2005 - 06.2008
- Development, implementation, and management team for Employee Benefit programs including Health, Dental, Vision, Accidental Death & Dismemberment, Long-term Disability, and Life insurance
- Managed 4 exempt and 2 non-exempt employees
- Designed and wrote processes for Benefits staff / department & hospital employees for clarity
- Administrator of Workers' Compensation Program overseeing day to day program and claims management including responsibility of the W/C Claims Manager
Workers' Compensation Review Nurse
Miami Valley Hospital
07.1997 - 06.2005
- Day to day management of Workers' Compensation Claims
- Aggressively managed Workers' Compensation claims for 2 hospital risks and 2 System Affiliate organizations resulting in decreased claims cost & lost time.
- Oversaw & directed TPA & Defense Counsel
- Increased personal knowledge of Workers' Compensation claims process by intensive work assisting employees with claims processing and understanding.
Occupational Health Nurse
Industrial Medical Center / St. Elizabeth Med Ctr
12.1991 - 07.1997
- Treatment of job related injuries and provided health monitoring at the Chrysler Dayton Thermal Products plant.
- Decreased OSHA recordable injuries
- Assisted injured workers with W/C claims process
- Developed & maintained excellent relationship with Union, Outsourcing company, and employees.
Education
MBA - Leadership
Franklin University
Columbus01.2004
BSN - Nursing
Wright State University
Dayton01.1998
ADN - Nursing
Sinclair Community College
Dayton, OH01.1991
Skills
- Supervisory & Management
- Communication
- Writing and editing
- Utilization Review
- Claims management
- Medical analysis / research
- Medical file review - MSA & Cost-Mitigation
- Inter-personal communication
- Occupational Health Nursing
- MS Office
Websites
Certification
- CCM - Certified Case Manager, Commission for Case Manager Certification (CCMC), 09/2015, 05/2020, 4217052
- Associate in Claims, The Institutes Knowledge Group
Affiliations
- The Kettering Holiday at Home Foundation, Inc. - Local non-profit organizing and managing a large 2-day Labor Day Festival
Timeline
Cost-Mitigation Specialist
Verisk
09.2023 - 01.2024
Medical Analyst - MSA
Verisk
03.2023 - 09.2023
Supervisor Workers' Compensation Claims
The Cincinnati Insurance Companies
07.2016 - 03.2023
Case Manager II
The Cincinnati Insurance Companies
11.2014 - 07.2016
Telephonic Nurse Case Manager
WorkStar Health Services
12.2011 - 10.2014
Workers' Compensation Program Manager
Premier Health Partners
06.2008 - 02.2011
Employee Benefits Manager - Health & Welfare
Premier Health Partners
06.2005 - 06.2008
Workers' Compensation Review Nurse
Miami Valley Hospital
07.1997 - 06.2005
Occupational Health Nurse
Industrial Medical Center / St. Elizabeth Med Ctr
12.1991 - 07.1997
MBA - Leadership
Franklin University
BSN - Nursing
Wright State University
ADN - Nursing
Sinclair Community College
Similar Profiles
CHRIS DALEYCHRIS DALEY
Enterprise Account Executive at VeriskEnterprise Account Executive at Verisk
DALTON ORVISDALTON ORVIS
Software Development Engineer in Test II at VeriskSoftware Development Engineer in Test II at Verisk
Kim Yan LimKim Yan Lim
Sales Director, Southeast Asia at VeriskSales Director, Southeast Asia at Verisk
Nayanmoni BaishyaNayanmoni Baishya
Client Lead at VeriskClient Lead at Verisk
Aniruth GadeAniruth Gade
Project Manager at Infosys LimitedProject Manager at Infosys Limited