Jennifer Mroz
Glen Ellyn
Summary
Knowledgeable [Desired Position] with strong background in claims management and effective risk mitigation. Proven track record of resolving complex claims issues and improving workflow efficiency. Demonstrated ability in team leadership and strategic problem-solving.
Overview
24
24
years of professional experience
Work History
Claims Manager
Advocate Health
11.2016 - Current
- Manage and verify insurance coverage for professional and general liability claims covered under AlSPC programs to resolution and closure
- Evaluate liability and damages and establish initial reserves based upon guidelines and monitor and adjust those reserves for both indemnity and expense through closure of the claim
- Manage a diary system for all claims
- Work with defense counsel on litigated cases to develop and execute strategy
- Provide legal analysis on legal issues
- Timely report claims to all the designated reinsurance companies per established requirements of the insurance program
- Identify cases and provide feedback to the appropriate stakeholders regarding any accounting, risk/insurance, operational, quality or patient safety issues identified throughout the course of the litigation process
- Negotiate and resolve by way of settlement, assigned asserted claims, attorney liens and lawsuits
- Prepare narrative and/or summary reports, financial reports and maintain and provide reports, logs or calendars on an as needed basis
- Review, approve and, if necessary, adjust outside attorney invoices and direct vendor invoices, through our electronic billing process
- Comply with all reporting requirements for CMS, NPDB, IDFPR and other governmental regulatory bodies as required
Professional Liability Specialist
ISMIE Mutual Insurance Company
01.2006 - 11.2016
- Establish contact with the insured, defense counsel, consultants, opposing counsel, claimants, and other concerned parties to gather facts
- Investigate and/or confirm coverage for new losses
- Facilitate coverage analysis with internal meetings, obtaining coverage opinions, and executing coverage position
- Participate in initial interview, relevant depositions, mediations, and pre-trial conferences
- Work with defense counsel to plan and execute defense strategies
- Evaluate liability and damages on individual claims through the establishment of injury estimates, use of Physician Review Committee (PRC) process and evaluation for settlement authority
- Negotiate high exposure claims
- Create cohesive, timely, pertinent loss advices for re-insurers
- Approve legal and expense invoices
Claim Service Representative
Illinois State Medical Insurance Services
01.2002 - 01.2006
- In take initial claim reports, initial coverage review, file creation, and delegating files to appropriate analysts
- Assign counsel to and monitor 150 - 200 deposition and respondent in discovery files
- Code and enter claim department bills daily and batch bills when necessary
Teacher
LakeView Family Center
01.2001 - 01.2002
- Tended to two to five-year-old children's educational and emotional needs and maintained order so that lead teacher could carry out lesson plan
- Carry out lesson plan if lead teacher out
Education
BA - English, Minor Creative Writing
DePaul Unive1-sity
Chicago, IL01.2002
Skills
- Claims analysis
- Claims investigation and research
- Policy interpretation
- Procedure implementation
Timeline
Claims Manager
Advocate Health
11.2016 - Current
Professional Liability Specialist
ISMIE Mutual Insurance Company
01.2006 - 11.2016
Claim Service Representative
Illinois State Medical Insurance Services
01.2002 - 01.2006
Teacher
LakeView Family Center
01.2001 - 01.2002
BA - English, Minor Creative Writing
DePaul Unive1-sity
Similar Profiles
Jennifer ThelenJennifer Thelen
Palliative Care Nurse Practitioner at Advocate HealthPalliative Care Nurse Practitioner at Advocate Health
Christopher WashingtonChristopher Washington
Patient Trasnport at Advocate HealthPatient Trasnport at Advocate Health
Djaton WardDjaton Ward
Financial Advocate at Advocate HealthFinancial Advocate at Advocate Health