Tyrina Montgomery
Summary
Exceptionally diverse background and experience in Workers' Compensation claims administration for Third Party Administrators, Self-Insured Employers/Groups, Insurance Carriers and Reinsurance. California Workers’ Compensation expert with multi-jurisdictional experience from both a carrier and third-party administrator perspective. Solid experience in program oversight of direct books of Workers' Compensation and Employer Liability claims at the insurance carrier level, for small to medium size commercial markets in retail, construction, transportation, healthcare, hospitality, oil and energy industries.
Overview
16
16
years of professional experience
1
1
Certification
Work History
VP Claims Manager - US
SiriusPoint America Insurance Company
12.2022 - Current
- Oversees direct book of Workers' Compensation claims at the carrier and reinsurance level totaling over 5,000 claims and $5M total incurred.
- Works directly with MGA’s and TPA’s on claims and strategies to drive the best result.
- Monitors for strict adherence to Program Management Agreements and Claims Guidelines.
- Conducts claims audits of the MGA’s and TPA’s to ensure proper adherence to handling instructions.
- Chairs roundtable discussions for reserves and settlements.
- Evaluates and approves reserves, payments and settlement requests up to $1M.
- Oversees quarterly claim reviews.
- Oversees litigation management file reviews with claims department, legal firms and vendor partners.
- Participates in internal management meetings, providing feedback regarding frequency, severity and other loss trends.
- Develops pertinent management reports for tracking results.
- Provides reinsurance clients with initial notices, periodic narrative and financial updates.
- Coordinate and perform reinsurance audits.
VP of Claims - Southern California
CorVel Corporation
03.2019 - 12.2022
- Managed the overall operation of the Workers' Compensation claims department with direct reporting of 200+ claims staff.
- Responsible for financial expenses and budgeting of branch office.
- Maintained high level of communication with AVP of Claims on all operations, utilizing metrics and data analytics/reports/dashboards to monitor production, claim inventory and volume, financial outcomes and to identify trends and results.
- Utilized data driven metrics to communicate individual, team, and departmental performance relating to production, significant achievements and to identify areas of opportunity for continuous improvement.
- Worked directly with the Executive Leadership team to develop KPI’s to drive high quality claims management practices and promotes timeliness, compliance, and consistency of the department’s work product.
- Monitored the work product for each of the direct reports for compliance with best practice compliance results, together with the implementation of action plans for sustained and/or improved compliance.
- Responsible for authority levels and review of complex coverage cases with varying authority levels.
- Worked in collaboration with all departments to lead or contribute to enterprise-wide projects.
AVP of Claims - Western USA
Energi Insurance Services
12.2016 - 04.2018
- Managed all aspects of a Workers' Compensation claims office to include TPA staff oversight in multi-jurisdiction regions.
- Provided training and technical expertise to the staff to assure proper adherence to the company best practices and special account instructions.
- Coordinated weekly reporting and claims presentation to carriers and reinsures.
- Assisted in the development and oversight of the cost containment programs within the company’s internal organization including managed care program, utilization review, telephonic case management, medical provider networks and bill review.
- Conducted internal monthly audits of claims to monitor compliance of company policy and procedures.
- Reduced costs by creating employee incentives and reward programs to achieve monthly closing ratio's and case closings.
Claims Program Manager - California
Brown & Brown formerly American Claims Management
03.2015 - 04.2018
- Responsible for the overall claims operation for several large California Self Insured Groups (SIG).
- Direct management oversight of a team of 20+ claims professionals.
- Responsible for the staffing, training and mentoring claims personnel.
- Created and presented all monthly, quarterly and annual cost savings reports to the client.
- Filed all state mandated self insured reports on behalf of the program.
- Conducted client on site presentations at monthly and regional meetings.
- Assisted in development of new business prospects as well as oversight on the transition and implementation plans for new accounts.
Senior Claims Specialist Team Lead - California
Berkshire Hathaway Homestate Companies
11.2007 - 06.2009
- Maintained a highly complex catastrophic loss case load.
- Directly responsible for large accounts requiring a high degree of customer service, documentation and file maintenance.
- Conducted claims handling from inception to final resolution.
- Negotiated successful claims settlement for complex and CAT cases, including MSA's, LCP's, structured settlements, annuities and repatriation services.
- Worked closely with CAT nurse case management team and medical managment vendors.
Skills
- Claims Management
- Account Management
- Oversight and Auditing
- Client Relations Operations management
- Training and Development
- Results-oriented
- Strong organizational skills
- Proven track record reducing claim costs
References
References and educational history available upon request
Certification
- State of California Self Insured Certification
- Insurance Education WCCA/WCCP
- California Workers Compensation Certified Designation
Timeline
VP Claims Manager - US
SiriusPoint America Insurance Company
12.2022 - Current
VP of Claims - Southern California
CorVel Corporation
03.2019 - 12.2022
AVP of Claims - Western USA
Energi Insurance Services
12.2016 - 04.2018
Claims Program Manager - California
Brown & Brown formerly American Claims Management
03.2015 - 04.2018
Senior Claims Specialist Team Lead - California
Berkshire Hathaway Homestate Companies
11.2007 - 06.2009
- State of California Self Insured Certification
- Insurance Education WCCA/WCCP
- California Workers Compensation Certified Designation
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