Summary
Work History
Education
Skills
Timeline
Certification
Overview
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Ronald D. Pope, M.B.A.

San Diego ,California

Summary

Professional in insurance sector with robust background in claims analysis. Known for meticulous approach to examining claims and supporting team objectives through effective collaboration. Reliable and adaptable, consistently contributing to process improvements and accurate claims resolutions. Proficient in problem-solving and critical thinking.

Work History

Manager of Claims and Quality Assurance

TransGeneral Life Insurance Co.
Pittsburgh, Pennsylvania
03 2009 - 08 2018
  • Managed and motivated employees to be productive and engaged in work.
  • Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
  • Controlled costs to keep business operating within budget and increase profits.
  • Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
  • Managed budgets effectively, ensuring optimal financial performance while investing in necessary resources for business growth.

Claims Analyst

HealthAmerica, Inc.
Pittsburgh, Pennsylvania
02 2003 - 12 2008
  • Managed a team of junior examiners, providing guidance and training for improved productivity.
  • Reduced claim resolution time by conducting thorough investigations and timely decisionmaking.
  • Coordinated with medical professionals to obtain necessary documentation for evaluating injury claims accurately.
  • Mitigated company risk by identifying fraudulent activities and implementing preventative measures.
  • Contributed to company growth by consistently meeting or exceeding productivity targets without sacrificing quality standards.
  • Collaborated with legal counsel on complex claims, ensuring compliance with regulatory guidelines.
  • Played an integral role in upgrading company software systems to streamline daily operations efficiently.
  • Negotiated settlements with claimants, balancing fairness with fiscal responsibility to the company.
  • Worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial.

Education

Baccalaureate Degree - Education And Advanced Biological Sciences

Waynesburg College
06.1993

Masters Degree - Healthcare Analytics And Business Administration

Duquesne University
01.2010

Skills

  • Document workflow
  • Claims review
  • Benefits review
  • Microsoft Office Suite
  • Policy investigations
  • Coverage determination
  • Legal proceedings knowledge
  • Subrogation expert
  • Microsoft Word
  • Familiar with fraud statutes
  • Underwriting knowledge
  • Skilled in IDX claims management system
  • Claims
  • Negotiation and mediation skills
  • Valuation knowledge
  • Accident scene investigations
  • Risk management
  • Healthcare Common Procedures Coding System (HCPCS)
  • Insurance policy coverage knowledge
  • Personal, casualty and property loss

Timeline

Manager of Claims and Quality Assurance

TransGeneral Life Insurance Co.
03 2009 - 08 2018

Claims Analyst

HealthAmerica, Inc.
02 2003 - 12 2008

Baccalaureate Degree - Education And Advanced Biological Sciences

Waynesburg College

Masters Degree - Healthcare Analytics And Business Administration

Duquesne University

Certification

  • Certified Professional Coder - California and Pennsylvania 2025

Overview

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1
Certificate

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Ronald D. Pope, M.B.A.