Michelle Randazzo

• Triage all suits and arbitrations. Evaluate all evidence submitted with review of all our documents to determine if case should be settled or defended.

• All cases are fully documented and those cases that are defended are prepared for trial

• All decisions are made with the best interest of the company

• Those cases that are settled are analyzed to determine if better offered in a bulk settlement or as a one-off settlement for best outcome

• Cases are fee scheduled and negotiated with attorney

• Communications and relation with attorney are crucial both internally and externally

• Attend meetings, analyze and communication is key, understanding of venues and outcomes at trials

• Implementations for continued improvements

• Testimony at Trial
• Preparation for Hearings
• Attend Hearings

• Negotiated and settled claims according to information presented through reports, research and data verification.
• Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
• Recommended settlement offers and negotiated payment arrangements.
• Investigated questionable claims to determine payment authorization.
• Supported long-term business strategies, generating feedback for process improvements.
• Responded to customer inquiries and delivered appropriate information after carefully researching provider investigations.
• Identified appropriate solutions to minimize issues and quickly solve problems.
• Analyze provider investigations, delays and outcomes. Processing settlement and pursing DJs and Affirmatives while balancing timely handling of the provider EUOs.

• Resolved customer complaints
• Established and enforced clear goals to keep employees working collaboratively.
• Provided ongoing training to address staff needs.
• Complied with company policies, objectives and communication goals.
• Identified and corrected performance and personnel issues to reduce impact to business operations.
• Coached staff members to develop long-term career goals.
• Maintained operating schedules to provide effective coverage for key areas and achieve objectives.
• Monitored employee productivity to provide constructive feedback and coaching.
• Evaluated processes and employee strengths to realign workflows with changing business demands.
• Reviewed completed work to verify consistency, quality and conformance.

• Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
• Delivered quality customer service to assigned, insured and claimants throughout entire claims lifecycle to promote service times.
• Verified details with policyholders and requested additional information.
• Reviewed documentation and accounts to gain full picture.
• Supported efficient handling of complex claims and followed up on open, denied or suspended claims to complete required line items.
• Processed No fault claims daily and expertly handled as many files with impeccable quality.
• Monitored reports to identify claims issues and worked with adjusters to resolve problems.
• Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
• Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
• Processed high volumes of No Fault claims efficiently while working in fast-paced environment.

• Processed billing, with explanations of benefits.
• Calculated payments in accordance with the fee schedule
• Issued denials, and processed payments.