Susanne Moranville
Saint Joseph,MO
Summary
Results-oriented Senior Claims Consultant with expertise in insurance claims management and dispute resolution. Specializes in TPA oversight, claims analysis, and process development. Drives efficient claim resolutions while enhancing workflows and strengthening stakeholder relationships. Experienced in training teams and optimizing operational procedures.
Overview
1
1
Certification
21
21
years of professional experience
Work History
Senior Claims Consultant- AVP
Lockton Companies, LLC
Kansas City, MO
05.2012 - Current
- Guide clients in developing and implementing best practices for internal claim management programs to enhance efficiency and effectiveness
- Evaluate and manage the quality of claim services provided by the insurance carrier, third party administrator (TPA) or other vendors
- Manage daily claims operations for national client including claim reporting and follow-up, TPA oversight and collaboration with project safety professionals on return to work
- Act as liaison between the client, insurance carrier and other vendors involved in the management of the claim process to ensure timely resolution of any claim-related issues
- Oversee TPA handling of workers' compensation claims for national program, advocating for client to achieve favorable outcomes
- Coordinate the TPA RFP process, including written and oral presentations and the transition to the newly selected TPA.
- Review and analyze claims; make recommendations and help establish plans of action for resolution of claims
- Analyze claim trends through loss history and data utilization to inform strategic decision-making
- Coordinate and participate in client claim quality audits.
- Provide basic workers' compensation training to new client employees
- Assess documents such as bills, invoices, contracts and other relevant paperwork related to the claims process.
Claims Analyst
RailCrew Xpress
Lenexa, KS
03.2010 - 05.2012
- Reviewed coverages, deductibles, determined liability and compensability, secured information and settled claims utilizing claims best practices
- Communicated daily with Corporate Claims Director, Third Party Administrator (TPA), and defense attorneys regarding liability claims including FELA claims and workers' compensation claims
- Assisted Corporate Claims Director and company attorneys in preparing cases for litigation
- Reviewed claims handled by assigned adjusters, advocated for prompt and economical resolution of pending files
- Assisted locations with their efforts to properly handle claim exposures including workers' compensation claims
- Reviewed attorney and carrier invoices and charges for accuracy and completeness, ensuring financial accountability
- Managed multiple spreadsheets tracking employee injuries, railroad employee injuries associated with the operation of the company and claim costs
- Managed the company's post-accident training program and ensured compliance of training within contract guidelines
- Implemented and managed a volunteer Return To Work program.
- Implemented and coordinated the process regarding driver non-regulated physicals in Nebraska.
- Key contact and joint decision maker in highly successful Texas Non-Subscriber RFP
Claims Adjuster II
Cameron Mutual Insurance
Cameron, MO
07.2005 - 03.2010
- Verified coverage details in the insurance policy for the reported loss
- Investigated claims through interviews with involved parties and collection of police reports and medical records to establish facts and liability
- Evaluated claims through information obtained from audio-taped statements, photographs and estimates to determine negligence
- Negotiated settlements with involved parties to achieve fair resolutions and maintain client satisfaction
- Authorized payment to claimants upon settlement of claims
- Trained new adjusters on company policies and procedures to ensure adherence to proper claims handling standards
Education
Bachelor of Arts - Psychology
Rockhurst University
Kansas City, Missouri01-1994
Skills
- Claims administration
- Client representation
- Data analysis
- Communication effectiveness
- Training and development
- Claims analysis
Certification
- Associate in Claims, Insurance Institute of America, 2008
- Associate in Risk Management-54, Insurance Institute of America, 2013
Timeline
Senior Claims Consultant- AVP
Lockton Companies, LLC
05.2012 - Current
Claims Analyst
RailCrew Xpress
03.2010 - 05.2012
Claims Adjuster II
Cameron Mutual Insurance
07.2005 - 03.2010
Bachelor of Arts - Psychology
Rockhurst University