Tracy Smack

• Managed 8 direct reports remotely. Responsible for managing litigation and compensatory teams to minimize potential client and/or losses, serve as a liaison between clients, upper management, and attorneys, provided support day-to-day management of client initiatives.
• Managed notifications received to ensure timely responses were required. Tracked and monitored litigated claim issues and provided reporting to management and clients. Prepared and distributed monthly management and executive reports.
• Reviewed and approved litigation reserves provided coaching and mentoring for timely resolution of suit/presuit demand claims handling for assigned MGA. Managed services for outside vendors (billing system, defense counsel) Reviewed and approved attorneys’ invoices. Identified trends, implemented workflow processes. Handled DOI complaints & CRN notices. Participated in depositions, mediations and trials when needed. Handle subpoena requests. Notarized answers and interrogatories.

• Managed 5 direct reports in the office and remotely. Reviewed and approve reserves, provided coaching/mentoring for timely resolution of claims & conducted monthly audited claim files. Manage service providers including attorney invoicing. Identified trends, implemented workflow processes & claim system enhancements to improve overall daily efficiency and work task. Handled Atty disclosure request, DOI complaints and CRN notices.

• Claims Unit Manager-PIP 03/2015-05/2019

Managed 6 direct reports in office. Reviewed and approve reserves, provided coaching/mentoring for timely resolution of claims & conducted monthly audited claim files. Manage service providers including attorney invoicing. Identified trends, implemented workflow processes & claim system enhancements to improve overall daily efficiency and work task. Handled DOI complaints and CRN notices. Conducted annual performance reviews. Presented large loss claim files via round table with senior mgmt.

• PIP Senior Representative-Litigation- representative 10/2014-03/2015

Reviewed & investigated claim file & policy to provide background for investigation and determine the extent of policy obligation for accurate payment. Contacts to insureds, claimant parties, physicians, attorneys, police officers to secure necessary claim information (this included verbal and recorded statements when needed). Evaluates facts supplied by investigation to determine extent of liability on behalf of insured under policy contract. Prepare/document reports on investigation, settlements or denials. Consistently monitor claim file reserves for indemnity and ALAE. Conducted case management review on outstanding inventory over 90days. Obtained releases and issued any indemnity owed. Assisted counsel with the preparing of defense on pre-trial suit claims, which included case management, reviewing and providing answers and interrogatories and participating in mediations, depositions and trials. Handled subpoena copy request.

• PIP III Representative-SIU representative 12/2012-09/2014

Reviewed/ investigated suspicious claims for potential insurance fraud by conducting & gathering evidence, interviewing insureds, providers, witnesses, claimants. Analyzing surveillance reports, examination under oath. Collaborated with the claims adjuster, underwriting and legal team to ensure comprehensible approach with claims investigation. Weekly R/T with senior management on progress of claims inventory. Trained front line reps within the company on how to recognize and identify potential fraud.

• Contract independent claims adjuster. Assigned multi-jurisdictional personal injury claims which involved coverage analysis of case law, policy and statutory interpretation for material misrepresentation, serious injuries, fatalities. Monitored and set reserves within authority. Resolved inventory promptly and equitably. Prepared, submitted and discussed claim files high in exposure and unlikely to prevail if litigated with senior management. Coordinate Benefits with Health Insurance, WC.
• Directed claims negotiations within allowable limit of $1.5 million and supported successful litigations for advanced issues.

• PIP Litigation Specialist 06/2007–05/2011
• Responsible for reviewing, investigating and processing semi-complex FL PIP Pre-Suit Demands and suits. Completed proactive investigations for prompt evaluation for early settlement discussion for suit files.
  • Independently evaluated claim based on preponderance of evidence presented. Addressed any discrepancies in claim file. Worked with attorneys to identify issues and attempted to mitigate additional costs that would incur further litigation by negotiating interest and fees and cost for plaintiff attorneys.
  • Documented file quality in key actions and decisions on file with reasoning noted in file and making sure deadlines are consistently noted and met.
  • Assisted counsel with preparing of defense on pre-trial suit claims, which included case management, reviewing and providing answers and interrogatories and participating in mediations, depositions and trials. Handled subpoena copy request.
  • Proficient in analyzing demands for validity and accuracy of payment. Negotiated fair settlements, when necessary, on suit files within scope of coverage and delegated authority.
• Assistant PIP Supervisor 06/2005–06/2007

Coached/mentored 3 trainees. Role included communicating quality and service standards to staff, establishing effective procedures for timely resolution of claims, developed metrics to track performance. Completed monthly quality audits, assessed/approved claim file reserves/payments. Conducted desk/phone audits and reviewed compliance of office diary standards.

• Level III Claims – Medical Representative 06/2004–06/2005

Handled complex multi-jurisdictional PIP claims with serious injuries/fatalities. Investigate & evaluate SIU claims of all complexity types in multi jurisdiction states. This includes identifying files with trends & patterns that require further SIU/NICB review.
•Provide direction to SIU investigator and defense counsel, request & monitor for EUO completion w/manager involvement. This includes participating in PIP Roundtable discussion and providing comprehensive suit evaluations and recommendations clearly outlined.
•Handled Arbitration claims following state specific criteria. This includes evaluating and making recommendations concerning the handling with best practices and cost containment.
•Evaluate & Negotiate Complex PIP claims by conducting Peer Reviews to assist with Negotiation and settlement of SIU claims.
•Assist claim associates with questions of moderate to severe complexity. Act as a mentor to Level 1& 2 Representatives, by providing teammates with legal and investigative knowledge in regard to file handling resolution, training and support. Provide mini–Team Unit seminars to Level 1 & Level 2 PIP Representatives on various Medical Management indicators

• Responsible for reviewing, analyzing, investigating and authorizing payments and determining payments for moderate to high complexity FL PIP and MP claims. Identifying complex coverage issues. Interpreting medical records regarding soft tissue injuries and objectives injuries to identify opportunities for IME’s and peer reviews. Resolved FL pre-suit files according to Fl Statute that were assigned to me.

• Reviewed policy coverage and documents/processes complex personal injury protection claims.

• Communicated and documented all written & verbal correspondence with customers and associates.

• Follow up any applicable subrogation. Coordinate benefits when applicable with Medicare, Medicaid, Health Insurance and WC.

Worker’s Comp Medical Review Technician (04/97-10/98):
Worker’s Comp Quality Assurance Representative (10/98-05/00):
• Responsible for paying, denying and investigating medical claims for various Workers’ Compensation for NY, NJ & PA. Responsible for taking new loss, investigating & resolving general liability claims for state wide employers. Provided customer service through resolution of problems for agents, employers and medical providers for both WC & General Liability.
• Conducted scheduled and random review audits for payment and procedural accuracy for Worker’s Compensation claims. Assisted in analysis of areas in which staff required additional training. Tracked quality control error results to identify patterns/trends within Cost Containment Unit for management review as well as providing feedback and coaching to team associates.

Underwriting Specialist (11/93-03/95):
Customer Service Supervisor (03/95-04/97):

• Analyze& Investigate medical risk for small business owner for medical coverage. Analyze information in insurance applications. Screen applicants on basis of set criteria. Contact field representatives, medical personnel, and others to obtain further information. Bind policy.
• Staffed and managed a 20-30-person department that provided customer service for health insurance for small business owners with major HMO’s. Effectively analyzed individual quality and productivity performance based on quality monitoring results and ACD reports. Assisted with on-site training to develop and implement systems to streamline office procedures which increased productivity.