Michelle Namisniak
OneGroup
Auburn,NY
1
Certification
25
years of professional experience
Results-driven leader with strong background in strategic management and organizational growth. Skilled in developing and implementing effective business strategies, optimizing processes, and driving team performance. Known for adaptability, effective collaboration, and delivering measurable outcomes in dynamic environments. Strong communication and problem-solving abilities, coupled with focus on fostering productive and positive team culture.
Work History
Director of Business Insurance Claims
4 Years- Provide guidance, coaching and direct supervision to staff on a daily basis.
- Conduct performance review discussions, establish performance and career development plans in collaboration with team members and company initiatives.
- Lead staff unit meetings
- Develop and administer departmental policies and procedures.
- Assist clients with issues regarding policies, programs and/or claims.
- Attend client meetings, participate in claim reviews & annual stewardship meetings with clients.
- Make recommendations to carrier and TPA partners regarding plans of action, claim resolution.
- Act as claims advocate on behalf of clients and assist client with claim issues.
- Review reserve and settlement amounts for approval.
- Provide team with technical training and claims handling guidance and direction.
- Identify and alert senior management to claims trends or issues.
- Resolve escalated policyholder and claimant issues related to specific claims.
Client Service/Claim Manager/Settlement Consultant
3 Years 9 Months- Build relationships with clients and brokers
- Prepare client reports and lead Stewardship Presentations
- Respond to claim technical and program related client questions/requests
- Client Accident Investigation and Reporting training
- Analyze Claim Reserving and strategize best practices to mitigate claim exposure
- Develop and Present Adjuster Training, ie, Claim Investigations, Reserving Practices, Settlements including MSA’s and Annuities, etc.
- Establish, Train & Audit to File Quality Guidelines, Protocols & Performance Measurements
- Support Sales staff by attending presentations and through client retention
- Manage Claim Professionals, Mentoring, Coaching, Driving Performance and Quality Claim Outcomes.
- File Quality Review audits, Supervisory Reviews and Attending Client Claim Reviews.
- Settlement of high exposure claims utilizing Annuities for Cost Reduction.
Workers Compensation Claim Manager
2 Years 3 Months- Manage a multi-jurisdictional team of 7 individuals
- Perform all related administrative functions including performance management/evaluation, coaching, mentoring, training and on-boarding of new employees.
- Driving optimal claim outcomes through supporting best practices, behaviors, performance management, data analysis, and creating/ implementing strategies to improve results.
- Overseeing a National Disposition team responsible for reducing age pending claims in excess of 4 years of age.
- Contributed toward 2017 results including 1,599 file resolutions, outstanding reserve reduction of nearly $80M, and favorable impact on medical/pharmacy spend through utilization of medical management resources and programs.
Cost Management Consultant- Northeast, Mid-Atlantic & Southeast Regions
2 Years- Responsible for controlling medical costs and reducing spend by focusing on core medical programs and services that promote return of injured employee to productivity/work in a timely and cost effective manner.
- Implement and train claims branch and client service staff on cost management programs, analyze regional results and performance, determine areas for improvement; develop and implement solutions.
- Conduct quality file reviews, round table discussions, provide recommendations to mentor/coach adjusters and help claim offices assess effective utilization programs and identify vendor performance quality issues.
- Participate in special focus projects or programs as subject matter expert. Identify/develop proposals for new cost management services/products. Liaison with internal clients and vendors regarding new products, training, updates, issues and workflows.
- Managing vendor relationships to ensure vendor is providing contracted services at required performance levels. Addresses vendor and field office performance issues and monitors performance.
Workers’ Compensation Specialist
11 Years 5 Months- Responsible for processing claims of all complexity levels in CT, MA, ME, NH, NY, RI and VT.
- Duties include the investigation, evaluation and disposition of claims. Making compensability decisions. Prompt establishment of clear, concise and accurate case estimates reflecting the probable ultimate cost of the loss at the earliest possible time.
- Negotiating settlements of claims.
- Develop rapport with client, team members, customers and injured workers.
- Compliance with customer request, completing status reports, claim reviews, State regulations and requirements.
- Controlling medical costs through utilization of Cost Management programs and processes. Coaching and mentoring less experienced adjusters and assisting with claim manager duties under supervision of Manager.
- Part of National Claim Audit team reviewing Claims for File Quality and Delivering Office Performance Results to Director of Claims.
Client Service Director
2 Years- Responsible to monitor client-program results and make recommendations.
- Act as client’s liaison, coordinating all RSKCo services.
- Develop strategies & new product ideas based on client input & service goals. Ensure execution of RSKCo’s claim service agreements.
- Develop renewal pricing at profitable rates.
- Participate in presentations to prospective and existing clients.
- Build ongoing relationships with clients and brokers.
Education
Bachelor of Arts - Public Justice
Skills
Relationship building
Strategic planning
Verbal and written communication
Decision-making
Certification
State of New York – Auto and Casualty Insurance Department Adjuster License. Multi-Jurisdictional claims handling & experience
PROFESSIONAL DESIGNATION
WCLS – Workers’ Compensation Claims Law Specialist. Legal Principles Claim Specialist
Timeline
Director of Business Insurance Claims
OneGroup
06.2022 - 06.2026Read More
Client Service/Claim Manager/Settlement Consultant
Triad Group
09.2018 - 06.2022Read More
Workers Compensation Claim Manager
CNA
06.2016 - 09.2018Read More
Cost Management Consultant- Northeast, Mid-Atlantic & Southeast Regions
CNA
06.2014 - 06.2016Read More
Workers’ Compensation Specialist
CNA
01.2003 - 06.2014Read More
Client Service Director
RSKCo
01.2001 - 01.2003Read More
State University of New York College at Oswego
Bachelor of Arts from Public Justice
Read More