KEMBERLEY A. COTTON
Highly motivated and dedicated professional with over 18 years of experience in the Insurance Industry. Proven capabilities and experience as a Processing Manager, Claims Resolution Specialist in Health and Workers Compensation Claims, Underwriter for Professional Liability Insurance, Convention Cancellation Insurance, Surety and Fidelity Bonds
Professional Experience:
Viant, formerly Concentra Preferred Systems, Rockville, MD 2005- 2010
Providing Healthcare payment services and solutions
SBOC Processing Manager
Managing the processing operations and the day to day planning and serving as a resource for problem- solving and resolution of the Small Bill Operating Center (SBOC).
- Collaborate with and provide managerial assistance to the Director in operational decision making
processes
- Oversee the generation of reporting processes; monitor and address productivity/performance
- Oversee team leads in monitoring compliance with all policies, procedures and workflows
- Oversee the handling of Provider Relations calls, monitor, assist and assign phone calls and written
request
- Disseminate new and/or revised procedures perform analysis and provide general support to the team
members and offer creative solutions for problem resolution
- Manage human resource issues including hiring and selection, training, performance management,
discipline, colleague retention and career development
- Monitor productivity reports for processor success and provider trends
- Work with CMT Management on system enhancements, upgrades and workflow
- Update, review and approve payroll on the Etime
Claims Resolution Specialist
Generating revenue by negotiating with providers on a variety of Health and Workers Compensation claims and maintaining client turn-around-time while enhancing relations with Hospitals and Physicians.
- Perform negotiations per company guidelines for Health and Workers Compensation claims
- Provided Workers Compensation training sessions to co-workers
- Utilize company databases and other resources to effectively research and evaluate Workers Compensation bills for the correct payment
- Negotiate settlement of Workers Compensation bills below state allowed fee schedule
- Develop and maintain positive, service –oriented relationships with clients/providers (Travelers,
Hartford, Broadspire, Coventry Health, Liberty Mutual, Cigna and United Healthcare)
Victor O. Schinnerer & Company, Chevy Chase, MD 2000- 2004
A division of J & H Marsh McLennan, a program administrator which handles a variety of Professional Liability Insurance programs.
Account Executive/ Underwriter
Underwriting for the Architects and Engineering Professional Liability Specialty Department
- Underwriting new business applications and renewals for a determination of rates to send quotes to
brokers
- Generating monthly reports for department meetings to inform the team of progress made monthly
- Special Task programs: Procedural Manual updates, Lotus Notes training, Competition Committee Task
Force, Renaissance project for a company wide computer upgrade
Seabury & Smith, Washington, DC 1997 - 2000
A division of J & H Marsh McLennan, a program administrator which handles a variety of Professional Liability Insurance programs.
Account Executive / Department Manager
Supervised employees in the ExpoPlu$ CCI program for Convention Cancellation Insurance; solicited and generated new revenue from clients and brokers.
- Traveling to attend conventions as an exhibitor for different Associations to promote CCI insurance
- Underwriting new business and renewal applications, submitting proposals, sending binders and invoices
for payment.
- Developed Department Procedures and Processing Manual
- Provided quarterly productivity reports.
- Prepared perfor...
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