Monique Allen
Queen Creek,AZ
Summary
Experienced insurance and risk manager, skillful at working and obtaining results in a rapidly changing business environment. Motivated and conscientious professional with experience in driving operations to improve organizational efficiency and ensure positive client experience. Demonstrated success in oversight of all company claims; leverage critical thinking skills to resolve complex claims across multiple lines of business and industries. Enthusiastic about building relationships with key stakeholders throughout the organization to address internal and external customer concerns as well as improve quality of service. Knowledgeable Risk Manager equipped with strategic planning and program leadership abilities honed risk mitigation. Establishes strong and successful policies to mitigate risk at each level and establish clear procedures for assessments, prevention and containment. Familiar with regulatory requirements to maintain strict controls.
Overview
15
15
years of professional experience
Work History
Senior Risk Manager
The Raley's Companies (Raley's, Bashas')
2021.10 - Current
- Lead enterprise risk management projects with a focus on safety, cost containment, Regulatory risk, and Credit risk
- Developed written protocols for managing third-party administrators; to direct proper and efficient handling of claims, gather all related data and estimate fiscal impact to the organization reducing outstanding liabilities by 30%
- Provide overall guidance, support, and resources to ensure contractual documents meet insurance requirements including bonds, letters of credit, certificates of insurance
- Direct and manage the administration of all commercial insurance programs- including property casualty, directors and officers, employment practices and fiduciary policies both fully insured and self-insured of coverage
- Oversee mitigation efforts which include resolution of work comp, general liability and automobile claims at the least possible cost and pursuing subrogation whenever applicable.
- Handled claims according to internal risk management policies, keeping liability minimized by leveraging expertise and available tools.
Claims Director
The Doctors Company
2019.04 - 2021.09
- Yield $100K in savings from implemented operational changes as well as improved quality and compliance to meet company enterprise risk management goals
- Pitch 60% of the recommendations accepted by the executive steering committee- include-vetting assigned law firms, reassign of caseload to claims representative/managers
- Direct 32 team members and managers
- The team consists of claims administrative support personnel
- Management includes oversight of the administrative protocols that impact on the organization's claims department which consists of 175 employees
- Design and implement by identifying best practices for claims management for consistency and training to empower employees to provide the best experience to external and internal customers
- Partner with Patient Safety, Business Development, Underwriting Operations, Marketing, and IT to implement technological systems to improve combined ratio to meet company metrics
- Recognized as the company's customer experience champion, led claims efforts to overhaul employee engagement; develop and build customer-centric foundations to distinguish the company from all other competitors
- Identified drivers for increased indemnity payments in comparison to other carriers in specific states; present and create corrective action recommendations to mitigate increased payments.
Claims Manager
The Doctors Company
2018.05 - 2019.04
- Supervised 400+ claim files including general and professional liability insurance within the Southwest claims department
- Managed a 20-person department and 7 direct reports
- Collaborated with claims leadership and other business units to oversee the restructuring of the administrative support team by creating call center dashboards to track the number of calls managed, abandoned calls, average call handle time, and institute after call surveys to maintain high-level service standards for internal and external customers to better align with company mission
- Consulted legal counsel on addressing coverage issues to achieve 100% compliance with company policy and procedures and state requirements
- Mentored 3 junior claims adjusters resulting in their promotions as Senior Claims Representative; implemented defense strategy resulting in winning 90%
- Spearheaded defense for cases proceeding to trial based on experience and venue knowledge within the state and analyze exposure including damages, liability, and causation issues
- Established formal training on best claims handling practices to advise the claims representatives and managers handling medical board and cyber liability claims
- Reduced 45% of associated expenses and coverage issues after designing and implementing written communication and company messaging training
- Acquired 30 accounts between 2018 to 2019 and retained 90% of current accounts achieving company new business goals of 89% retention and adding 15% new accounts
- Screened, interviewed, and hired 6 new employees.
Claims Supervisor
The Doctors Company
2015.10 - 2018.05
- Created reserve recommendations on 120 high exposure cases valued at $1M+; provide updates on conclusion of high exposure claims to the executive committee
- Managed 4,800 faxes and emails, 3,000 calls, and 86% of first reports, ensuring an expedited response from members, agents, and other company partners
- Increased favorable survey results by 75% providing mentorship to 10 customer service agents providing training on claims intake calls
- Led expansion of claims service team which impacted 200 claims employees as project manager to assist company goals to streamline process and increase productivity
- Designed training curriculum used by 60 employees to encourage professional development and efficiency
- Regional oversight of 7-person administrative claims team involving license, medical board issues, and investigation by state medical boards
- Built pilot program to include 5 administrative managers, 30 claim assistants
- I created metrics for service to external and internal customers
- Managed 7 of the claims administrative support personnel and 2 claims representatives
- Oversaw call center functions, coaching agents on dealing with difficult phone calls
- Presented weekly dashboard information that included-handled calls, average talk time, handle ratio, average ready and average not ready time statistics
- Improved post-call feedback by 60% using data from dashboards to coach team members on sub-optimal, and to create related training materials
- Collaborated with various business units-customer service, operations to identify ways the call center could assist agents with efficient first claims reporting
- Worked with the legal department to draft written responses to explain policy when coverage issues were identified at the time of first reporting a claim.
Sr. Claims Specialist
The Doctors Company
2010.08 - 2015.10
- Manage in-depth interviews of providers, contacting unrepresented claimants, opposing counsel, and negotiating fair timely resolutions, identifying causation and liability issues and make case plan recommendations including settlement authority and reserve changes, when appropriate
- Saved the company $50K by conducting timely investigations of over 300+ complex, high severity claims and lawsuits
- Managed 10 large multi-specialty accounts with favorable claim outcomes to ensure the company met 89% retention goal and increased new member count
- Presented claims information to group executives addressing concerns about claims development, reserves and collaborated with agents and underwriters when premium questions arose.
Risk Claims Examiner
Oregon Health & Science University
2008.12 - 2010.08
- Increased data entry accuracy by 85% after analyzing professional and general liability claims files, using a risk information management system
- Reduced 50% off-site and inter-office storage costs after managing and implementing the department document management system
- Trained and managed 4 temporary employees
- Developed guidelines and revised process instructions to facilitate cross training and encourage efficient use of office resources
- Reviewed 100 monthly requests for medical care offered off the main campus as the Off-Campus Authorization Chair and recommended protocols to automate the process which included verification questions
Education
Certificate - Completed 18 Hours of Training in Strategic Negoti
Strauss Institute For Dispute Resolution, Pepperdine University School of Law
Malibu, CA05.2015
Certificate - Completed Incident Command System Training ICS-200
Federal Emergency Management Agency
Portland, OR02.2009
MBA - General Business
Lorry I. Lokey Graduate School of Business At Mills College
Oakland, CA05.2006
Skills
- Alternative Dispute Resolution
- Negotiation strategy development
- Vendor management
- Microsoft Suite-Word, Excel, PowerPoint, Teams, pivot tables
- Oracle accounting applications
- Timekeeper software (Kronos, UltiPro, ADP)
- Knowledge of HIPAA transaction sets, regulations/privacy laws
- Presentations for diverse audiences
- Customer service management
- Regulatory compliance
- Data analytics
- Internal controls
- Claims Review
Professional Affiliations And Certificates
- Vice President/President Elect of Oregon Society for Healthcare Risk Management (2010-2011)
- Certified Health Equity Alliance Facilitator – Kaiser Permanente (2010)
Timeline
Senior Risk Manager
The Raley's Companies (Raley's, Bashas')
2021.10 - Current
Claims Director
The Doctors Company
2019.04 - 2021.09
Claims Manager
The Doctors Company
2018.05 - 2019.04
Claims Supervisor
The Doctors Company
2015.10 - 2018.05
Sr. Claims Specialist
The Doctors Company
2010.08 - 2015.10
Risk Claims Examiner
Oregon Health & Science University
2008.12 - 2010.08
Certificate - Completed 18 Hours of Training in Strategic Negoti
Strauss Institute For Dispute Resolution, Pepperdine University School of Law
Certificate - Completed Incident Command System Training ICS-200
Federal Emergency Management Agency
MBA - General Business
Lorry I. Lokey Graduate School of Business At Mills College
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