Kathleen Fitzgerald

Experience

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  Oxford Health Plans

  Apr 1995 - Aug 2000

  Resolved issues pertaining to beneifts, policies and procedures for brokers and benefit administrators.Facilitated actions related to system updates, business exceptions, enrollment and billing issues for customer base.Took lead role in the development and implementation of protocols for the renewals of group policies during transition into a new service structure. Articulated technical information on products, policies and procedures to both internal and external customers.Responsible of design and implementation of Intermedia Marketing script. Created daily ACD reports for team efficiency for team efficiency tracking.Trained new representatives. Filled role of supervisor for escalated calls

  • Dedicated Group Service Associate

    Jun 1997 - Aug 2000

  • Customer Relations

    Apr 1995 - Jun 1997
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  MetLife

  Sept 2000 - Apr 2013

  Managed a pending of Casualty Claims. Utilized strong written, verbal and organizational skills to provide high quality customer service. Identified coverage issues and effectively interpret insurance contracts. Investigated, evaluated and negotiated claims to ensure compliance with state regulations and company policies.Managed a high pending of Litigation, 93a/Bad faith, Umbrella policies/High exposure, Home Office Referral files and Uninsured/Underinsured Motorist casualty claims. Using strict interpretation of the applicable policy, performed complex coverage investigations.Decided referral of cases with questionable loss descriptions and manage defense handling of denied cases. Coordinated with counsel to direct defense of cases and effectively resolve lawsuits. Traveled frequently to depositions, trials, mediations and arbitrations.Facilitated litigation round tables. Mentored front-line casualty adjusters. Monitored legal and other expenses. Show less

  • Senior Litigation Claims Adjuster

    Jan 2009 - Apr 2013

  • Casualty Claims Adjuster

    Sept 2000 - Jan 2009
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  Homesite Insurance

  Mar 2014 - Dec 2020

  • Conducted internal quality assurance claim audits and telephony quality reviews for the claims department (first party homeowner; homeowner’s liability, subrogation, commercial and FNOL) following the Department’s standards and procedures• Audited claims processes including, but not limited to, coverage analysis, investigation, valuation, reserving, and accurate disposition of claim• Maintained quality data and execute quality audit processes• Collaborated with Quality Assurance Manager, as well as Team Leads and Managers to advise on trends and recommend areas of improvement (i.e. education, training and mentoring of claims examiners)• Communicated with management to ensure full understanding of financial and operational objectives, risks, controls and observations• Assisted in the ongoing design, modification and implementation of the claim’s quality review program• Assisted in the creation of calibration Quality Assurance training sessions and assist claims employees to increase knowledge and skills necessary to achieve improved results Show less • Investigated, evaluated and negotiated property damage and bodily injury claims ranging from small property damage to policy limit exposure to ensure compliance with state regulations and company policies• Effectively utilized SIU department and vendors to appropriately minimize loss payments• Actively participated in roundtable discussions regarding coverage and liability issues as well as overall improvement to the department and it's procedures• Consistently maintained high quality and well documented files that adhere to the most current standard operating practices, resulting in strong QA scores Show less

  • QA Analyst

    Jan 2016 - Dec 2020

  • Liability Adjuster

    Mar 2014 - Jan 2016
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  American Family Insurance Claims Services

  Jan 2021 - Aug 2021

  Enterprise Policy and Procedure Administrator- Best Practices

  • Writes claims handling guidelines for a variety of specialties/topics for the Enterprise• Research and respond to a number of complex coverage questions• Collaborates with upper management regarding policies and procedures• Participates in the Diversity and Inclusion committee regarding onboarding and continued employee training