Matthew D. Jacobs

Assistant Vice President

Responsibilities
Mr. Jacobs’ responsibilities include reviews of Third Party Administrators, Governmental Entities and Pools, as well as insurers and reinsurers on behalf of our domestic and international clients. He is responsible for the oversight and management of liability and workers’ compensation excess claims for governmental entities and pools.

Professional Experience
Mr. Jacobs has more than 16 years of experience in the insurance field, specializing in bodily injury claims in multiple states. He has extensive experience in litigation management, fraud identification, and cost control. Additionally, Mr. Jacobs has expertise as a bodily injury claims adjuster and a claims auditor.

Community and Professional Activities
Mr. Jacobs has earned his Bachelor of Science degree from Bentley University, majoring in Marketing.
Outside of the office, he enjoys spending his free time with family and friends.  His favorite hobbies are traveling and hiking.

Ellen V. Gariepy

Vice President

Responsibilities
At Northshore, Ms. Gariepy reviews and supervises the handling of casualty claims on behalf of excess insurers and reinsurers. She is specifically responsible for the oversight and management of liability and workers’ compensation excess claims for governmental entities and assists in directing our governmental entity program.

Professional Experience
Ms. Gariepy has 30 years of experience managing multi-line casualty and training units, as well as being in-house claims manager for insurance companies handling claims in multiple states. She has worked on the NLC Mutual claims management program in increasingly responsible roles for 22 years.

Arbitration & Litigation Support

Northshore’s highly qualified associates and consultants and experts provide insight to insurance arbitration and litigation that is often sought out by attorneys from insurance defense litigation divisions of even the most seasoned law firms. Our services are provided by professionals holding designations including JD, CPA and CPCU. As insurance and reinsurance claims become larger and more frequently contested, these larger losses have a significant impact on a company’s bottom-line. It is therefore, critical to engage well-qualified arbitration.

Life & Disability Audits

On behalf of risk-taking clients, we perform complex audits of the eligibility, claims and operations of life, short term disability and long term disability programs.

These audits include verification of eligibility under the subject life and/or disability coverage, evaluation of complex claims, and detailed overviews of all aspects of operations pertaining to the programs insured.

The observations and findings identified in these audits are measured against industry standards and practices, which allows us to provide recommendations to strengthen the audit subject’s operation, thus allowing a more successful partnership between the audit subject and its risk bearer.

Governmental Entity Audits

We are regularly retained by Municipal Pools; Risk Retention Groups (RRGs); Captives; Domestic Insurers; and Reinsurers to review captives and their service providers (TPAs) to evaluate the quality of claims handling, reserving and outward reporting as compared to the basic tenets of proper claims handling and agreed upon contractual metrics. Classes of business include workers’ compensation, general liability, police and public officials liability, APD, property, and employee medical benefits.
We also act as the reinsurance claims department for a captive reinsurer, managing and reporting on hundreds of workers’ compensation, liability and property claims.

Medical Excess Claims Conference

Litigation & Consulting

Property & Casualty

Claims Management

Accident & Health

Damage Valuations & Assessments

Some form of monetary value, or other economic loss is an element in many insurance claims settlements. Catastrophic Damages, by definition, exceed damages that typically would be classified as “normal” damages. They typically involve damages that cover a more widespread geographical area from a single event or class of business than do other types of damages.

Catastrophic Damages affect damaged parties or entities to different degrees of Economic Loss. For example, after the tragic events of 9/11 we worked with global insurers and reinsurers and conducted numerous file and field claim and data audits to sort out and report the actual and potential effects of workers’ compensation losses to their respective layers and blocks of business.

Put simply, once the event has occurred, the client needs to know what the future economic exposure of the loss will be, and we can help with that determination.

Our insurance and reinsurance experience allows us the ability to break the process down into its comprehensible components and provide the client the meaningful data and information necessary to properly reserve for Economic Damages.

Expert Witness

Northshore’s experienced Health and Property/Casualty consultants and experts provide insight to insurance arbitration and litigation that is often sought out by litigators from the insurance defense litigation departments of even the most seasoned law firms.

Northshore’s Expert Witness Support services are provided by highly qualified associates and consultants, who hold respected professional designations including JDs, CPAs and CPCUs.

Northshore’s Expert Witness Support services include:

• Providing objective, expert advice in insurance-related arbitration and litigation, insurance coverage and claims handling issues;
• Advising and testifying on customs and practices in the insurance industry, including best claims handling practices, underwriting criteria and accepted industry practice and standard of care and management issues;
• Comparing and analyzing policy forms and endorsements for coverage and/or exclusions with respect to specific claims;
• Undertaking electronic or field audits of the disputed business or claim;
• Researching or drafting Affidavits of Merit and Expert Witness Reports for submission to courts in support of the Client’s position;
• Auditing premium development under retrospective, deductible and other loss sensitive rating plans, as well as permissible rates and changes; and,
• Providing assistance and advice to in-house and outside counsel during all stages of arbitration and litigation.

Lea M. Zurek HIA, MHP

Assistant Vice President

Responsibilities
At Northshore, Ms. Zurek manages a staff of auditors who audit and review specific excess, HMO Re and Provider Excess claims. She is also responsible for the supervision and training of new MEF employees, and manages the run-off of large reinsurance programs including disability, Workers’ Compensation, and life insurance claims. Ms. Zurek conducts aggregate excess claim reviews and serves as a consultant for Medical Excess Stop Loss claim issues within the industry and provides litigation and managed care support. Ms. Zurek is proficient in establishing claim reserves and serves as an industry expert in this area for several clients.

Professional Experience
Ms. Zurek, who joined Northshore in 1991, began her insurance career in 1978. She has technical and management experience in administration of group health benefits. Her experience includes claims adjudication, claims department management, training protocols, and development and implementation of internal audit processes.

Strategic Consulting Services

Northshore will work with you to deliver a visionary growth plan to protect or enhance an existing position or successfully develop a new strategic position, which ensures its success. We have real and far-reaching experience helping companies resolve their insurance and reinsurance claims and operational challenges and optimize opportunities. Class settlements due to catastrophic damages affect damaged parties or entities to different degrees, covering widespread geographical area. Our insurance and reinsurance experience allows us to break the process down into its comprehensible components and provide the client the meaningful data necessary to properly reserve for these damages.

Reinsurance Audits

For the risk-taking market, we conduct claim department management studies, assessing the quality and efficiency of systems and procedures and their impact on reporting; reserving; and resolution — “the 3-Rs.”

Additionally, we review ceding companies and their providers of service (TPAs) to assess staffing; underwriting; premium administration; technical claims handling; commutation possibilities, and other items of interest to our risk-taking clients.

Workers’ Compensation Audits

We represent the interests of domestic and international excess carriers and reinsurers to ensure that the underlying exposures are recognized promptly and handled appropriately.

We visit service providers contracted by these risk-takers and are often asked to monitor the handling and reserving of workers’ compensation claims and assist in their final resolution. We also manage reinsurance exposures generated by workers’ compensation carve-out business.

The experience faced by municipalities and other governmental agencies such as police departments, are unique, and they require an exceptional knowledge base to recognize and evaluate strategies and exposures. Our staff has handled the claims that arise from these exposures for more than 30 years.

TPA Audits

On behalf of risk-taking clients, we review the designated service provider’s management, reporting and resolution of claims or law suits associated with our clients’ business.

These service providers have been delegated certain authorities, such as claims investigation, settlement and payment; subrogation and salvage recoveries; or litigation management. We review these authorities as relates to agreements, guidelines and structures imposed upon them, as well as industry-best practices.

Many of the service providers have either developed or purchased sophisticated claims management systems which allow remote access. With appropriate access, we have been completing more and more of the claim reviews remotely, saving our clients thousands in travel-related expenses.

Coverholder Audits

On behalf of risk-taking clients, including Lloyd’s Managing Agents, London Market and Domestic (U.S.) Insurers, we review the production entity’s management of business to our clients.

These entities have often been delegated certain authorities, such as underwriting, premium collection, and claims handling, and we review these authorities as relates to agreements, guidelines and structures imposed upon them, as well as industry-best practices.

Generally, we see our role as an extension of the risk-taking client. We are often tasked with securing and reporting information; reviewing underwriting, compliance and claim records; and forming opinions based upon what we have reviewed.

Repricing Services

Utilizing our proprietary claim system, we incorporate Medicare and/or Medicaid fee schedules into a table of valuations based on excess policy terms. We produce fee values to be applied during the claim adjudication process. Additionally, we offer pre-adjudication comments that highlight policy limits, highlight potential duplicates, and identify treatments and conditions that may require additional review to determine eligible expenses.

Medical Excess of Loss

We evaluate and verify excess of loss medical claims and report findings to clients and reinsurers. We recommend reimbursements on behalf of our clients acting as their in-house claims department.

Our results have saved millions of dollars for our clients by confirming policy terms, conditions and limitations are applied correctly based on the underlying risk.

HMO Reinsurance & Provider Excess of Loss

Utilizing a well-trained staff of experienced managed care claims professionals, supported by a proprietary Claims Processing System, we quantify, verify and reprice excess claims. Our evaluation and adjudication experience in this class allows us to assist in the drafting of policy language and to analyze and resolve coverage issues. We also conduct implementation visits and administrative and technical reviews of managed care providers and third-party administrators, as well as HMOs and other health plans.

Employer Stop Loss Specific Excess

We monitor and evaluate the handling of self-funded employer stop loss specific claims, establish reserves, and report to our clients and reinsurers. We recommend reimbursements and manage the claim payment process on behalf of our clients, acting as their in-house claims department. We also provide additional capacity to excess claims departments with claim back log support utilizing client claim platforms or our own reporting tools.

Premium Audits

We offer premium audits at the request of the risk-bearing entity. Ours comprehensive audit includes an understanding of the audit subject’s premium administration and audit samples to test that the premium received accurately traces to census.

Carrier / Reinsurance Audits

Reinsurance audits are most often commissioned by the “Lead Reinsurer” on behalf of the market. We confirm the business mix underwritten to the reinsurers, and that the business complies with the intent of the parties to the reinsurance agreement(s). Most often, the audit components involve underwriting, claims and premium administrations.

MGU Audits

We review and evaluate all phases of an MGU’s operations; including underwriting administration, premium administration, claim administration, TPA oversight, data protection and disaster recovery. Findings are discussed with the Program Manager with the goal to provide information regarding industry standards and practices, and to strengthen its overall administration.

Specific Claim Audits

We offer audits of specific excess claim reviews at the request of the risk-bearing entity, or as a due diligence on behalf of the Program Manager. Findings are discussed with the Program Manager with the goal to provide information regarding industry standards and practices, and to strengthen the claims administration.

TPA Audits

It is critical for employers to have a complete understanding of the capabilities and competencies of the TPA’s administration. To that end, we work directly with employers and brokers/consultants to formulate a scope of audit that meets due-diligence requirements and concerns. These audit scopes are designed unique to the concerns and/or wishes of our client and can include one or any of the following: Claim Operational Audit, Stratified Statistically Valid Random Sample Claim Audit, Random Sample Claim Audit; Focused Top 100 Claims Paid Audit; and, Targeted Issues Audits such as Duplicate Payments, Coordination of Benefits; Eligibility; Stop Loss Submission, etc.

Aggregate Claim Audits

Since the inception of our firm, we have audited literally thousands of aggregate claims. Our role is to audit the TPA’s submitted calculation and apply the Plan Document and Stop Loss contract terms and provisions to all elements of the claim. We provide our comprehensive reporting which details our recommended reimbursement as well as all details regarding the findings.

T. Scott Garner CPA, MBA

Senior Consultant

Responsibilities
Mr. Garner’s current responsibilities include conducting Coverholder reviews on behalf of various London Markets and Lloyd’s syndicates, conducting reviews for domestic and international reinsurers of claims and premium data in the context of relevant coverage documents.

Mr. Garner is also responsible for financial reviews of P&C insurers, MGA/MGU’s and the clients of Life & Health reinsurers.

Professional Experience
Mr. Garner has been in the insurance industry for 19 years. He has had 9 years of experience in account management and reinsurance underwriting of commercial property and casualty lines, and commercial and private passenger automobile for two major U. S. reinsurance companies. He also has experiences in project management, management reporting, quality control, cost accounting and internal auditing.

Additionally, before joining with Northshore, Mr. Garner operated his own consulting firm in which he provided expertise in new product development, contract reviews, and reinsurance program structures, among other services.

Norman C. Tardif, JD

Executive Consultant

Responsibilities
Mr. Tardif handles and oversees audits of employer stop loss, provider excess and HMO reinsurance, governmental entity, professional liability, delegated authority, and workers’ compensation classes of buisness.

Professional Experience
Mr. Tardif has provided claims management services, including auditing of insurers, self-insureds, and third party administrators since 1976, prior to which he had six years of claims adjusting and supervisory experience. As an attorney, he can offer an expanded perspective to claims management.

Steven M. Tilden

Assistant Vice President

Responsibilities
At Northshore, Mr. Tilden conducts detailed claim reviews of specific excess, HMO Re and Provider Excess claims on behalf of issuing carriers and interested reinsurers. He also assists in audits of third party administrators and managing general underwriters. Mr. Tilden also managed the run-off of large reinsurance programs including disability, workers’ compensation and life insurance claims.

Professional Experience
Mr. Tilden has been involved in the medical claim industry since 1985. He has experience in claims adjudication, technical oversight, customer service, quality review, training and development, and eligibility verification.

Joy Keener-Borresen

Assistant Vice President

Responsibilities
At Northshore, Ms. Keener-Borresen conducts provider excess claim reviews as well as detailed claim reviews of specific and aggregate excess claims on behalf of issuing carriers and interested reinsurers. She also assists in audits of third party administrators and managing general underwriters, and provides litigation support and contract interpretation on behalf of both insurers and reinsurers.

Ms. Keener-Borresen also provides consulting expertise on behalf of interested reinsurers regarding the management of their managing general underwriters.

Professional Experience
Ms. Keener-Borresen, who joined Northshore in 1996, has been involved in the medical insurance industry since 1988 working for MGUs, TPAs and life & health insurance companies. Her experience includes processing managed care and specific excess loss claims, assisting in aggregate audits, adjudicating claims on a variety of insurance products, including health, life, disability and international policies as well as customer and provider relations, staff training, and assisting in the development of an international claims department.

John W. Kosar

Assistant Vice President

Responsibilities
At Northshore, Mr. Kosar’s responsibilities include reviews of Third Party Administrators, Governmental Entities and Pools, as well as insurers and reinsurers on behalf of our domestic and international clients. He is responsible for the oversight and management of liability and workers’ compensation excess claims for governmental entities and pools.

Professional Experience
Mr. Kosar has more than 20 years’ experience managing multi-line claim operations, specializing in workers’ compensation and self-insurance in multiple states. He has extensive experience in litigation management, cost mitigation strategies, process efficiencies, while staying abreast of industry trends and their potential effects on clients, and has effectively developed and managed long term client relationships, based upon establishing confidence and trust.