GLENN DOUGLAS

PIP/MPC Claims Specialist | Auto Insurance Claims

• Investigate and evaluate auto accident claims by determining coverage eligibility, verifying policy terms, and analyzing causation related to injury and medical expenses.
• Review medical records, treatment plans, billing statements, and supporting documentation to assess the necessity, reasonableness, and relatedness of medical treatment.
• Manage first-party benefit claims including Personal Injury Protection (PIP) and Medical Payments Coverage (MPC), covering medical expenses, rehabilitation, lost wages, replacement services, and funeral benefits.
• Identify, pursue, and manage subrogation opportunities by investigating third-party liability, coordinating recovery efforts, and maximizing reimbursement for claim payments made.
• Negotiate settlements with healthcare providers, attorneys, and claimants to resolve medical bills, disputed charges, and injury-related claims within policy limits.
• Handle complex disputed claims, litigation matters, and legal inquiries by responding to subpoenas, attorney demands, and lawsuits while ensuring compliance with policy and regulatory standards.
• Detect potential fraud, billing discrepancies, and questionable treatment patterns, escalating concerns to Special Investigations Units (SIU) when necessary.
• Collaborate with internal departments, legal teams, medical professionals, and subrogation units to resolve claims efficiently and improve recovery outcomes.
• Consistently manage a high-volume caseload in a fast-paced, metrics-driven environment, achieving monthly closure goals while maintaining accuracy and compliance.
• Demonstrate empathy, conflict resolution, and de-escalation skills when assisting customers through sensitive and emotionally challenging injury claims.

• Ensure positive client experiences through high quality service and communication.
• Responded to shared inbox inquiries from clients and internal partners within expected time frames, ensuring clients received timely updates throughout resolution.
• Function as the primary point of communication for our medical, vision and dental and 401K carriers.
• Review and work all open cases for clients.
• Run and work full and quick audit reports to ensure all member records are accurate and transactions.
• Manage client deliverables, track progress and complete assigned work through company planning tools Maintain accountability for inbound and outbound files.
• Maintained carrier and client SFTP setup and completed updates. Reviewed incoming data files and reported carrier discrepancies.
• Completed risk mitigation reporting, including audits and team activity, to enhance oversight and accountability.
• Communicated daily to alert team of issues with client data, reviewing warnings and errors during daily stand-up and identifying responsible team members for resolution.

• Collaborated with Fiserv clients/banks to optimize use of Fiserv Statement products, addressing service requests, troubleshooting issues, and providing timely updates.
• Independently handle client calls and cases with minimal supervision
• Researched and resolved reported problems through effective problem-solving techniques.
• Thoroughly track, organize, and document all support related activities ensuring clients receive regular follow-up and the status is tracked and consistently updated.
• Provide daily support to users of various computer systems including answering questions, analyzing problems, and quickly forming solutions to return systems to proper operation.
• Simulate or recreate customer problems to resolve user operating difficulties.
• Communicate customer suggestions for enhancements.
• Attend ongoing training to achieve level of technical skills needed to solve more complex problems.
• Cultivated strong relationships with clients/banks, contributing to high levels of client satisfaction.
• Effectively manage work through task driven queues while multi-tasking in a fast- paced call center environment
• Support banks through personalized, caring, and simple interactions.

• Provide consultative service to field regarding Financial Advisor Platform tools and other applications such as Portfolio Insight, Income Center, and Client Financial Review.
• Consistently met and exceeded department metrics and service goals while building relationships with our partners in the field.
• Consulted with Financial Advisors regarding retirement planning software programs.
• Created SQL queries to test and validate data remediation projects including narrative explaining test results.
• Construct SQL queries to convert data validations from specialized query tool (CAS Collateral Analysis System).
• Researched data from general ledger and/or system of record to explain variances identified in reconciliation process.
• Supported and performed business analysis on data gaps and data enhancements for general ledger reconciliation process.

• Provided excellent customer service to customers.
• Handled incoming calls efficiently resolving a variety of basic customer service inquiries.
• Consistently met established performance and quality standards.
• Handled multiple tasks (i.e., talking with customers while accessing information in a computer).
• Offer alternatives and options to overcome objections.
• Displayed strong written and verbal communication skills.
• Displayed strong critical thinking and decision-making skills.
• Displayed ability to multi-task across technical platforms.
• Located and interpreted complex information from several databases.

• Delivered exceptional customer service to Cigna members via phone, email, and chat, enhancing member satisfaction.
• Addressed inquiries, resolved issues, and offered support with a focus on empathy and understanding.
• Educated members on Cigna products, services, and benefits.
• Resolved billing and payment issues while fulfilling customer material requests, ensuring timely support and member satisfaction.
• Analyzed Explanation of Benefits to clarify member coverage details.
• Investigated, evaluated, negotiated, and settled claims.
• Applied knowledge of policies, and insurance regulations when determining coverage, liability, & damages.
• Collaborated with cross-functional teams to identify solutions, streamlining processes and enhancing overall customer experience.
• Verified Physician assignments and oversaw pre-certification and authorizations for treatments.
• Utilized strong critical thinking and decision-making skills to resolve complex issues.