Lorraine Osipczuk
Plainfield
Summary
Seasoned Claims Professional with over 30 years of experience in disability, life, AD&D, and workers’ compensation claims. Adept at case management from intake to resolution, including appeals and hearings. Expertise in medical claim analysis, legal compliance, investigative research, and third-party coordination. Recognized for analytical thinking, medical knowledge, and exceptional communication across stakeholders including legal, vendors, and claimants.
Overview
33
33
years of professional experience
Work History
Senior Disability Examiner
Illinois Municipal Retirement Fund (IMRF)
11.2022 - 08.2024
- Oversaw high-level claims and appeals, combining duties of Claims Specialist and Examiner.
- Partnered with legal, medical, and vendor stakeholders to ensure compliant and accurate determinations.
- Managed end-to-end appeals process, including preparing files for legal hearings and ensuring redacted documentation met Pension Code standards.
Disability Claims Specialist
05.2018 - 10.2022
- Case managed short-term, long-term, total permanent disability, and appeal claims.
- Led vendor coordination for IMEs, psychiatric evaluations, and vocational assessments.
- Created detailed claim summaries, case timelines, and internal reports; tracked departmental vendor usage and budgets.
Disability Claims Examiner
05.2017 - 05.2018
- Reviewed incoming medical records and initiated follow-ups.
- Assessed claim validity and severity using medical rationale and plan guidelines.
- Delivered direct claimant and employer communication and claim servicing.
Workers’ Compensation Claims Examiner
IHA (IOS Staffing Services)
10.2016 - 05.2017
- Managed workers' compensation claims for IL and IA clients.
- Conducted interviews, reviewed medicals, and determined compensability.
- Prepared files for litigation review and negotiated employer cost containment.
Claims Adjudicator – Disability, Life/AD&D
UNITE HERE HEALTH (TPA)
09.2000 - 03.2016
- Investigated and processed complex disability and death claims.
- Coordinated autopsy/toxicology reports for AD&D cases.
- Ensured accurate adjudication in line with federal/state law and NAIC guidelines.
- Processed IRS year-end reporting and claims corrections.
Medical Claims Examiner
Claim Strategies, Inc.
06.2000 - 09.2000
- Processed 150–175 daily medical claims, ensuring accuracy per plan policies and federal codes.
Medical Claims Analyst
United Chambers
01.1997 - 01.2000
- Reviewed and adjudicated high-volume claims.
- Conducted pre-existing condition investigations and processed rescissions when appropriate.
Referral/Case Management Coordinator
MetraHealth
01.1994 - 01.1997
- Initiated HMO/POS medical referrals and determined service approvals.
Utilization Review Coordinator
Health Care Compare
01.1992 - 01.1994
- Reviewed hospital admissions and medical necessity; approved/denied services.
Education
Disability Claims Processing Diploma -
IMRF Disability Examiner Training Program
Oak Brook, ILEMT-A (Basic) - undefined
Westmont Fire Department
Medical Assistant Diploma - undefined
Bryman Technical College
Nursing Program Coursework
Triton College
Skills
- Short-Term & Long-Term Disability Claims
- Life, Accidental Death & Dismemberment
- Workers’ Compensation (IL & IA)
- Claims Appeals & Hearings
- Medical & Legal Documentation Review
- Vendor & Third-Party Coordination
- Microsoft Office, Excel, Adobe Acrobat
- HIPAA Compliance & Pension Code
- Accounts Payable/Receivable
- Customer & Claimant Service
Timeline
Senior Disability Examiner
Illinois Municipal Retirement Fund (IMRF)
11.2022 - 08.2024
Disability Claims Specialist
05.2018 - 10.2022
Disability Claims Examiner
05.2017 - 05.2018
Workers’ Compensation Claims Examiner
IHA (IOS Staffing Services)
10.2016 - 05.2017
Claims Adjudicator – Disability, Life/AD&D
UNITE HERE HEALTH (TPA)
09.2000 - 03.2016
Medical Claims Examiner
Claim Strategies, Inc.
06.2000 - 09.2000
Medical Claims Analyst
United Chambers
01.1997 - 01.2000
Referral/Case Management Coordinator
MetraHealth
01.1994 - 01.1997
Utilization Review Coordinator
Health Care Compare
01.1992 - 01.1994
EMT-A (Basic) - undefined
Westmont Fire Department
Medical Assistant Diploma - undefined
Bryman Technical College
Nursing Program Coursework
Triton College
Disability Claims Processing Diploma -
IMRF Disability Examiner Training Program
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