Michael Carberry
Swansea,MA
Summary
Knowledgeable, efficient and skilled Senior Claims Examiner with proven expertise in handling high-value and complex claims. Oversees work of junior staff to keep claims handling accurate and within guidelines. Well-versed in managing escalations, reserves and claims audits.
Overview
36
36
years of professional experience
1
1
Certification
Work History
Senior Claims Examiner
Safety Insurance
Boston, MA
06.1990 - Current
- Reviewed and evaluated complex insurance claims to determine coverage, liability, and damages.
- Analyzed medical records to identify discrepancies between the claim and treatment history.
- Attended court proceedings as a representative of the company when necessary.
- Evaluated and investigated assigned claims to recommend workflows, alternate decisions and improvements to future claims handling.
Claims Examiner
Aetnagroup
Brockton, MA
05.1988 - 06.1990
- Reviewed medical records and documents to determine coverage eligibility of claims for insurance benefits.
- Paid and processed claims within designated authority level.
- Completed required investigations on referred files within established timeframes.
- Processed claims payments and denials in accordance with company procedures.
- Communicated effectively with policyholders to explain claims decisions.
- Negotiated settlement terms with claimants within authorized limits.
Education
Bachelor of Science - Management Science
U Mass Dartmouth
North Dartmouth, MA06-1986
Skills
- Litigation Management
- Policy Interpretation
- Claims Processing
- Verbal Communication
- Insurance knowledge
- Guidewire fully trained
Certification
I am licensed in all New England States RI, CT, NH, VT, ME.
Affiliations
- Played golf since college and have been involved in some teaching of golf on the weekends.
Timeline
Senior Claims Examiner
Safety Insurance
06.1990 - Current
Claims Examiner
Aetnagroup
05.1988 - 06.1990
Bachelor of Science - Management Science
U Mass Dartmouth