About the Firm

Wakely and Associates, Inc. is a third party administrator based in Largo, Florida. Since its formation in 1969, the Firm has grown with a reputation for professionalism, ethical business practice, and responsive service. Currently the Firm has over 350 employees.

Wakely and Associates, Inc. provides administrative services to life and health insurance and reinsurance companies. The Firm owns and operates its own state-of-the-art computer facility. Procedures, practices and computer operations are all HIPAA compliant. The Firm is authorized to perform third party administrative services in all states.

Wakely and Associates, Inc. has grown to be one of the largest TPAs in the Southeastern United States by providing high quality services to its clients at affordable prices. The Firm relies on invitation and referral as the primary sources of business. The Firm is proud of its reputation and ability to provide professional services. You are invited to consider these services and resources. For further information on services, please contact the Firm's office or visit their web site at:

Wakely and Associates, Inc.
8545 126th Ave. N. Ste 200
Largo, FL 33773-1502
Phone: (727) 584-8128 · Fax: (727) 584-5613

www.wakelyinc.com

 

Meet the TPA Founders

John J. Anthony, FSA

Professionally, he is recognized as a Fellow of the Society of Actuaries (FSA). He earned his Bachelor of Science Degree in Actuarial Science from Drake University.

Mr. Anthony joined the Firm in 1974 after three years of experience with a large mutual insurance company. His consulting and third party administration experience includes most areas of life and health insurance company operations.

Raymond J. Biscoglia, FSA

Professionally, he is recognized as a Fellow of the Society of Actuaries (FSA). He earned his Bachelor of Business Administration degree in Actuarial Science and his Master of Actuarial Science degree from Georgia State University.

Mr. Biscoglia joined the Firm in 1976. His professional experience includes most areas of individual life and health insurance.

John Anthony and Raymond Biscoglia retired effective April 1, 2008.

Meet Senior Management

W. Randolph Samples, CPA, FLMI
President & Secretary

Professionally Mr. Samples is recognized as a Certified Public Accountant (CPA), a Fellow of the Life Management Institute (FLMI) and is a Member of the American Institute of Certified Public Accountants. He has Bachelor's degrees from the Georgia Institute of Technology and the University of Texas at Arlington.

Prior to joining the Firm in 1998, Mr. Samples had 24 years of experience in the life insurance industry in positions ranging from staff accountant to chief financial officer, chief administrative officer, and director.

Mark Postove, ASA
Vice President & Director of Information Technology

Mr. Postove is Director of the Information Technology Section. Professionally, he is recognized as an Associate of the Society of Actuaries (ASA). He earned his Bachelor of Science degree in Mathematics from Davidson College.

Mr. Postove entered the actuarial profession in 1976 and joined the Firm in 1998. For the previous 17 years, he was an independent software developer in the insurance industry. He has extensive experience in the design and development of insurance administrative systems. He oversees all IT and Model Office functions.


Administrative Services

Our Administrative Services Section utilizes a staff of experienced insurance professionals and its computer facilities to furnish clients with a wide variety of services in the individual life and health insurance market. Through a widely licensed third-party administration operation this Section can perform essentially any function normally associated with an insurance company's home office operation.

Services

Underwriting of life and health products
Automated policy assembly and policy issue
Premium billing and collection and commission processing
General ledger accounting
Automated interfaces for agent inquiry of new business status
Automated interfaces for financial reporting, production reporting,
and other requirements as needed
Claims adjudication
Policyowner services
Complete Treasury services, including all banking functions and unclaimed property reporting
Reserve processing services
Statutory and GAAP reserve preparation
A&H experience analysis and rate increase filings
Reinsurance accounting and reporting

Administrative Services Management

William P. Anthony, FLMI
Human Resources Manager

Mr. Anthony is the Human Resources Manager with the Firm's Home Office Support Section. Professionally, he is recognized as a Fellow of the Life Management Institute (FLMI). Mr. Anthony oversees functions pertaining to Human Resources, Electronic Imaging, Mailroom and Reception. He earned his Bachelor of Science degree in Business from Florida State University in 1990. Mr. Anthony joined the Firm in 1998, bringing with him 7 years of managerial experience in the Human Resources field.

William M. Reynolds, FSA, MAAA
Manager Actuarial Administration

Mr. Reynolds is the Actuarial Manager of the Firm's Administrative Support Department within the Administrative Services Section. Professionally, he is recognized as a Fellow of the Society of Actuaries (FSA) and a Member of the American Academy of Actuaries (MAAA). He and his staff currently provide actuarial support in the areas of reserve valuation, rate filing and experience analysis. Mr. Reynolds joined the Firm in 1997 after earning a Master of Arts degree in Mathematics from the University of South Florida.

Sharon S. Goodman, ASA, MAAA
Administrative Actuary

Ms. Goodman is an actuary in the Administrative Support Department. Professionally, she is recognized as an Associate of the Society of Actuaries (ASA) and a Member of the American Academy of Actuaries (MAAA). Academically, she earned her Bachelor of Science degree in Mathematics from Worcester Polytechnic Institute in 1990. Ms. Goodman joined the firm in 2001 after working for several large insurance companies. Her experience includes valuation, financial reporting and reinsurance of individual health and life insurance products.

Darcey Shaffer, ACS, FLMI
Compliance Administration Manager

Ms. Shaffer is the Compliance Manager of the Firm’s Administrative Support Department within the Administrative Services Section. Professionally, she is recognized as an Associate, Customer Service (ACS) and Fellow of the Life Management Institute (FLMI). Academically, she earned her Bachelor of Arts Degree in Insurance from Illinois Wesleyan University in 1985.

Ms. Shaffer joined our Firm in 1996 bringing over ten years experience of life and health insurance underwriting from a large insurance company. She moved to our Compliance Section in 1998 and currently is responsible for our Firm’s license renewals, annual reporting to the state departments and overseeing continued compliance of the Firm’s clients in our administrative operations.

Timothy S. Grooms, CMA, FLMI
Finance Manager

Mr. Grooms is the manager of the Firm's Finance Department within the Administrative Services Section. Professionally, he is recognized as a Certified Management Accountant (CMA) and Fellow of the Life Management Institute (FLMI). He earned his Bachelor of Science degree from the University of South Florida in 1989.

Mr. Grooms joined the Firm in 1989, after several years of experience in the accounting department of a life insurance company. He oversees the Firm's accounting, finance, and treasury functions for the Administrative Services Section. He is also experienced in the preparation of Statutory Annual Statements and the associated electronic filings.

Heather Bosley, FLMI, HIA, ACS, HCSA, AIAA, AIT
Policy Administration Manager

Ms. Bosley is the Manager of the Firm’s Policy Administration Department within the Administrative Services Section. She is responsible for the customer service provided by the Health Division’s Policy Owner Service teams. Professionally, she is recognized as a Fellow of the Life Management Institute (FLMI), a Health Insurance Associate (HIA), Associate, Customer Service (ACS), Healthcare Customer Service Associate (HCSA), Associate, Insurance Agency Administration (AIAA) and Associate, Information Technology (AIT). She earned her Bachelor of Science in Business Administration from the University of Central Florida in 1993.

Prior to joining the Firm in 2004, Ms. Bosley had 9 years of insurance experience ranging from Customer Service, Policy Issue, Agent Licensing, Commission Accounting, Business Analysis and Quality Testing.

Darlene M. Johnson, FLMI, CPCU
Consumer Affairs Manager

Ms. Johnson is the manager of the Firm's Consumer Affairs Manager within the Administrative Services Section and plays a supporting role for Policy Administration. Professionally, she is recognized as a Fellow of the Life Management Institute (FLMI) and a Chartered Property Casualty Underwriter (CPCU).

Ms. Johnson joined the Firm in 1981, bringing with her 16 years experience in data processing and policy administration with a large insurance company. After working as a computer programmer during the design and implementation phases of the Firm's insurance administration system, she assumed the position of operations manager in 1984. In this role, she was responsible for customer service and consumer affairs. She developed and coordinated administrative procedures for all functions performed within the Policy Administration Department.

Shelia B. Granger, FLMI
Life Policy Administration Manager

Ms. Granger is manager of the Firm's Life Policy Administration Department within the Administrative Services Section. Ms. Granger joined the Firm in 2007. Professionally, she is recognized as a Fellow of the Life Management Institute (FLMI). She has a Bachelor's degree from West Georgia College in Carrollton, Georgia. Prior to joining the Firm in 2007, she had over 25 years of experience in the Policyholders Service Department and Agency Department of a life insurance company. She is responsible for customer service, policy issue and claims for the life business.

Debra S. Klein, ACS, FLMI
New Business Manager

Ms. Klein is the manager of the Firm's New Business Department within the Administrative Services Section. Professionally, she is recognized as an Associate, Customer Service (ACS) and Fellow of the Life Management Institute (FLMI). She earned her Bachelor of Business degree from the University of Wisconsin in 1991. Prior to joining the Firm in 1999, Ms. Klein had 9 years experience in scheduling, workflow analysis and business procedures.

Sue Schmidt
Claims Manager

Ms. Schmidt is the claims manager of several of the Firm's largest Medicare Supplement clients within the Administrative Services Section. She joined the Firm in 1999 after 20 years of insurance industry experience for a large third party administrator. Her areas of expertise include inventory management and project consulting of daily operations, with proven results. Ms. Schmidt's primary accountability is to help implement and oversee the claims adjudication operation of the Firm's two largest Medicare Supplement clients.

Donna Walters
Claims Manager

Ms. Walters is the claims manager of several of the Firm’s largest Medicare Supplement clients as well as other supplemental health insurance coverages within the Administrative Services Section. She joined the Firm in 1991 after 13 years of policyholder services and claims adjudication experience. Ms. Walters oversees the claims adjudication functions for Medicare Supplement and other supplemental health insurance coverages.

Nicole Howard-Wade
Assistant Claims Manager

Ms. Howard-Wade is the assistant manager of the Firm’s Long Term Care Claims   Section.  Nicole earned her Bachelor of Arts and Science degree from Tennessee State University. Prior to joining the Firm in 1998, Ms. Howard-Wade specialized in the individual health and long term care markets, with emphasis in product interpretation, medical review, and customer and client relations.   She oversees the daily operations and claims adjudication functions for all Long Term Care clients. 


Information Technology & Home Office Support

The Information Technology and Home Office Support Section provides the following services to all sections of the company:

Hardware and software support
Software development
Coordination and facilitation of the exchange of information with clients
Communication systems
Incoming and outgoing mail
Printing
Imaging
File storage and retrieval
Security systems
Human resources
Reception

Information Technology & Home Office Support Management

Mark Postove, ASA
Vice President & Director of Information Technology

Mr. Postove is Director of the Information Technology Section. Professionally, he is recognized as an Associate of the Society of Actuaries (ASA). He earned his Bachelor of Science degree in Mathematics from Davidson College.

Mr. Postove entered the actuarial profession in 1976 and joined the Firm in 1998. For the previous 17 years, he was an independent software developer in the insurance industry. He has extensive experience in the design and development of insurance administrative systems. He oversees all IT and Model Office functions.

David Carpenter
Manager - Information Technology Applications

Mr. Carpenter manages the Applications area of the Information Technology Department. He earned his Bachelor of Science degree in Business Administration from Sonoma State University. Prior to joining the Firm in 2006, he spent 14 years in the insurance industry in various management roles related to application development, document automation, customer service, and quality assurance. He manages the Firm's technical staff of programmers and analysts.

David Borquez, MCSE, CCNP, CNA
Assistant Manager - Information Technology Systems

Mr. Borquez manages the Firm's Information Technology infrastructure, Voice Communications, and IT Systems personnel. He earned his Bachelor of Science degree in Computer Science from San Diego State University. He is also a veteran of Desert Shield and Desert Storm. When Mr. Borquez joined the Firm in 2005, he was a sixteen year veteran of the Information Technology industry. He is an expert in Microsoft operating systems, Cisco networking solutions, network engineering and security and has extensive management experience in large multi-location organizations where he implemented and managed IT Departments for over twelve years.

Burton Cobb, FLMI, CCP
Senior Life Specialist - Information Technology

Mr. Cobb is Senior Life Specialist in the Information Technology Department. Professionally, he is recognized as a Fellow of the Life Management Institute (FLMI) and as a Certified Computer Professional (CCP). Mr. Cobb joined the Firm in 2007, bringing over 35 years of experience in the life insurance industry. His expertise includes all aspects of the software systems used for the processing and management of many types of insurance policies. He also has extensive experience in the conversion of insurance products to administrative systems.


HIPAA Status

Wakely and Associates, Inc. is a third party administrator that administers Medicare Supplement benefits. At this time we are currently accepting standard (EDI) claim transactions from Medicare, and non-standard (paper) claims from providers and policyholders. We accept all HIPAA transactions indicated below, via a web-based gateway, directly from providers upon the complete implementation of the Transactions and Code Sets standards. We are not planning a relationship with clearinghouses for the collection and distribution of this information. However, we will continue to receive Medicare claims electronically from Medicare contractors, and therefore in most instances we will receive 837's without the need for you to submit them directly.

Listed below are the HIPAA Transactions and Code Set Standards and our current status regarding HIPAA compliant transactions.

Transaction/Code Set
Currently Supported
Transactions
 
Eligibility/Benefit Inquiry & Response (270/271)
Yes
Claim Rqst for Additional Info & Response (275/277)
NA
Claim Status Request & Response (276/277)
Yes
Request for Review & Response (278)
NA
Premium Payment (820)
NA
Benefit Enrollment & Maintenance (834)
NA
Claim Payment Advice (835)
Yes
Claims (Dental, UB92's, HCFA's) (837)
Yes

 

Medical Data Code Sets

 
ICD-9 (1-3)
Yes
NDC (National Drug Code)
No
CDT
NA
HCPCS & CPT-4
Yes

 

Non-Medical Data Code Sets

 
Provider Taxonomy
No
Claim Adjustment Reason Codes
Yes
Claim Status Codes
Yes
Claim Status Category Codes
No
Decision Reason Code
Yes
Remittance Advice Reason Code
Yes