Kathryn Malcolm
Kitchener,ON
Summary
Organized & detail-oriented team player, dedicated to improving efficiency, productivity & profitability. Experienced with fraud detection, risk assessment, and mitigation strategies. Utilizes advanced analytical techniques to identify potential fraud and implement preventive measures.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Claims Representative, Accident Benefits
Definity Insurance
01.2024 - Current
- Reviewing, investigating, evaluating and settling accident benefit claims
- Confirming details of claims while liaising with customers and/or their legal representatives
- Assessing coverages while applying interpretations of policy wordings and priority rules
- Processing applications for specified benefit claims
- Reviewing treatment plans and clinical notes; determining if insurer examinations are reasonable
- Reviewing fraudulent claim referrals from business lines
- Collaborating with colleagues on claim investigations, shareholders meetings and coverage meetings
- Arranging, attending and reviewing transcripts of Examination Under Oaths
- Maintaining detailed records of all investigations conducted, providing valuable data for trend analysis and future case management efforts
- Denying fraudulent claims when required utilizing the Statutory Accident Benefits Schedule
- Presenting to the business line on trends and how to identify fraud
- Coordinating with specialists on LAT applications for positive dispute resolution
Structured Settlement Support Analyst
McKellar Structured Settlements
02.2022 - 11.2023
- Provided support to level two analysts, associates, principals & shareholders
- Opened, closed & managed AB and tort files
- Reviewed, summarized, & sent medical reports to various life companies
- Maintained strong understanding of changing policies & regulations for individuals and businesses in the industry
- Circulated legal documentation including contracts for signature prior to sending to life companies for final review
- Performed quality assurance to assess accuracy of data entered into databases
- Answered phone promptly & directed incoming calls to correct offices
- Confirmed appointments, communicated with clients, & updated schedules
- Attended client & company meetings while recording meeting minutes
Private Investigator/Team Leader
Larrek Investigations
04.2018 - 01.2022
- Conducted file intake and prepared files for initial days of surveillance and locates
- Investigated individuals claiming disability benefits including attendant care fraud
- Ensured critical deadlines were identified & met with time maximization to match internal and client protocols as well as account contracts
- Collected documentation such as witness statements, video recordings and OSINT to support case findings and compiled into concise final reports
- Prepared, uploaded, & edited surveillance video as well as tested & reviewed new software's & technologies to streamline & better processes
- Interviewed, hired & trained new employees
- Monitored team performance & provided constructive feedback to increase productivity & maintain quality standards
- Supervised team members to confirm compliance with set procedures & quality requirements while ensuring a cohesive end product
- Active member of Health & Safety committee & employee Social Committee.
Education
Ontario College Diploma - Protection, Security & Investigation (PSI)
Conestoga College
Kitchener, ON05.2018
Office Administration & Business Courses -
Conestoga College
Kitchener, ON05.2016
Skills
- Report Preparation and Process Enhancement
- Presentation Development and Delivery
- Scheduling
- Data Collection & Research
- Time Management
- Team Collaboration and Leadership
- Deadline Adherence
- Microsoft Suite
- Data Collection & Research
- Time Management
Certification
- PI - Certified Private Investigator
- CPIO/ Toddington International- Advanced Internet & Online Investigations Course
Volunteer History
- Concordia Club, Kitchener, ON, 06/01/18, Present, Board of Directors, current 2nd Vice President, previous 2nd Treasurer
Timeline
Claims Representative, Accident Benefits
Definity Insurance
01.2024 - Current
Structured Settlement Support Analyst
McKellar Structured Settlements
02.2022 - 11.2023
Private Investigator/Team Leader
Larrek Investigations
04.2018 - 01.2022
Office Administration & Business Courses -
Conestoga College
Ontario College Diploma - Protection, Security & Investigation (PSI)
Conestoga College
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