Michelle Davis
Oxford,MA
Summary
Litigation Claims Specialist with 4+ years of experience managing attorney-represented bodily injury claims through resolution, including trial exposure and policy limit evaluations up to $250,000. Skilled in analyzing complex medical records, assessing causation and permanency, and developing defensible valuation strategies in collaboration with defense counsel. Promoted into Claims Specialist role with independent settlement authority up to $25,000 and participation in tenders up to $100,000. Seeking to transition into medical professional liability to apply litigation and medical analysis expertise to complex healthcare claims.
Overview
19
19
years of professional experience
Work History
Claims Specialist, Casualty (Promoted from Sr. Claims Representative)
MAPFRE Insurance
Webster, MA
04.2022 - Current
- Manage attorney-represented bodily injury litigation claims from inception through resolution.
- Evaluate liability, causation, and damages exposure on claims with policy limits up to $250,000.
- Exercise independent settlement authority up to $25,000 and collaborate on tenders up to $100,000.
- Conduct detailed medical record review including operative reports, diagnostic imaging, specialist consults, and permanency findings.
- Assess complex injury claims involving surgical intervention, future treatment projections, and long-term impairment.
- Develop litigation strategy in partnership with defense counsel, including discovery review and trial preparation discussions.
- Prepare comprehensive exposure evaluations for supervisory and consultant review on policy limit cases.
- Analyze comparative negligence, venue risk, and jury exposure trends when establishing valuation ranges.
- Negotiate settlements in high-exposure injury matters.
- Maintain compliance with regulatory standards and internal claim handling guidelines.
Customer Service Representative II (Billing – Enterprise Contact Center)
MAPFRE Insurance
Webster, MA
11.2020 - 04.2022
- Resolved complex billing and policy inquiries through detailed account analysis and problem resolution.
- De-escalated high-stress situations using active listening and solution-focused communication.
- Contributed process improvement ideas to enhance operational efficiency.
- Cross-trained in AS400 and Guidewire systems.
Owner / Director
Michelle’s Little Treasures Family Childcare
Oxford, MA
09.2014 - 07.2020
- Founded and operated licensed childcare business, overseeing compliance, safety protocols, and financial management.
Senior Administrative Assistant
UMass Memorial Medical Center
Worcester, MA
07.2007 - 01.2014
- Supported physicians and nurse practitioners in a high-volume clinical environment.
- Reviewed medical documentation to obtain insurance authorizations and ensure compliance with coverage guidelines.
- Communicated directly with insurance carriers regarding medical necessity and documentation requirements.
- Maintained confidential patient records in compliance with healthcare regulations.
- Coordinated cross-departmental communication to support continuity of patient care.
Education
Bachelor of Science - Social Work
Bridgewater State University
Associate of Arts and Sciences - Human Services
Quinsigamond Community College
Skills
- Guidewire
- AS400
- ECM
- Microsoft Office Suite
- Citrix
- Microsoft Teams
- Google Workspace
- Zoom
Websites
Core Competencies
- Medical Record & Causation Analysis
- Litigation Management
- Policy Limit Exposure Evaluation
- Settlement Negotiation Strategy
- Defense Counsel Collaboration
- Trial Preparation Support
- Complex Injury & Permanency Evaluation
- Risk Assessment & Documentation
Timeline
Claims Specialist, Casualty (Promoted from Sr. Claims Representative)
MAPFRE Insurance
04.2022 - Current
Customer Service Representative II (Billing – Enterprise Contact Center)
MAPFRE Insurance
11.2020 - 04.2022
Owner / Director
Michelle’s Little Treasures Family Childcare
09.2014 - 07.2020
Senior Administrative Assistant
UMass Memorial Medical Center
07.2007 - 01.2014
Bachelor of Science - Social Work
Bridgewater State University
Associate of Arts and Sciences - Human Services
Quinsigamond Community College