Insurance Manager
Resume:
Marylou Jimenez
Netcong, NJ **857
SUMMARY: Contract Specialist with 32 years of benefits and administrative
experience at a fortune 500 company. Demonstrated ability to provide
leadership in a fast paced changing environment.
Qualifications include:
. Solid Special Projects Skills
. Excellent Time Management Skills
. Strong Facilitation & Presentation Skills
. Detailed Oriented and Strong Decision Making Skills
. Strong Verbal and Technical Writing Skills
. Strong Understanding of Contractual and Medical Terminology
. Ability to Work as a Team Player
. Self-Starter with the Ability to Motivate Others
. Ability to Work Independently with Minimal Supervision
PROFESSIONAL:
SOLIX, INC.
Parsippany, NJ
Associate Manager, PIA, Auditor (Feb 2014 to present)
Responsibilities include reviewing grant eligibility, resolving issues and
questions that applicants may have in regards to receiving the help they
are entitled to receive for internet services. Review all program forms and
invoices and supporting documentation from applicants as well as the
service providers that participate and ensure conformance with program
rules and completeness and accuracy of all information.
PRUDENTIAL GROUP INSURANCE CONTRACT DIVISION
Roseland, NJ
Contract Specialist (2006-2013)
I was responsible for drafting life, disability and TDB and DBL statutory
disability documents to support changes of business which includes the
development of non-standard language. My responsibilities included drafting
contracts, amendments, riders, certificates and agreements. My
accountability includes meeting target dates for document delivery to
Account Representatives and Brokers with accurate quality documents that
comply with all applicable state insurance regulations and division
requirements.
PRUDENTIAL DISABILITY CLAIM MANAGEMENT SERVICES
Livingston, NJ
Disability Consultant (1997-2006)
Responsibilities included managing complex Long Term Disability claim
files, assisting Disability Claim Managers by being available at all times
and switching gears when necessary. Compiled data off our reporting system
and download the necessary information onto excel. Letter writing and
communicating verbally with clients, claimants and physicians on a daily
basis.
PRUDENTIAL HEALTHCARE
Rockaway, NJ (1981-1997)
Administrative Consultant (1992-1997)
Worked closely with HR department to resolve issues, concerns and questions
associates had regarding employee's benefits, attendance issues,
performance issues, etc.. Monitored workflow, quality, and production for
a division of 150 associates. Conducted meetings to inform supervisors of
company needs and expectations. Authorized overtime. Coaching and
counseling supervisors. Completed and conducted performance appraisals.
Developed and trained supervisors. Complied and monitored weekly, monthly
and quarterly reports. Maintained and updated memorandums on activities to
reduce risks and keep procedures in place for control. Headed up the
psychiatric unit. Received bonus for heading up conversion to new claim
system.
Assistant Claim Consultant (1989-1992)
Technical support to technicians and claim examining staff, written and
verbally. Reviewed and responded to Executive, Presidential and Insurance
Department complaints. Handled complaint phone calls from irate insurers.
Composed written materials to the Medical Department and reviewed
responses. Worked in a multi-case division and dealt with out side clients
on a daily basis. Attended client meetings on a regular basis. Received
bonus and interim increase for handling transfer of large case.
Supervisor (1986-1989)
Monitored workflow, quality and production for 20 claim examiners. Attended
supervisor meetings, conducted unit meetings to inform staff of company
needs and expectations. Authorized overtime. Handled technical and
overpayment referrals. Over signed claims beyond claim examiners
authority. Assisted examiners with difficult claims. Coaching and
counseling associates. Completed and conducted performance appraisals.
Developed and trained staff. Completed monthly and quarterly reviews and
reports. Performed daily count of claims. Monitored attendance. Composed
written documentation of associates who fail to achieve standards.
Technician (1983-1986)
Completed technical referrals and provided technical support to claim
examining staff. Made eligibility decisions on complex claims, appeals and
high dollar claims. Composed written explanation and denial letters to the
insured. Written explanations to examiners on how to pay complex claims.
Taught a six week claim examining class of 20 new hires.
Claims Examiner (1981-1983)
Processed health claims including Coordination of Benefits, Medicare, and
Medicob claims. Checked trainees.
EDUCATION: University of Phoenix-Business Management - Completed 8 courses
Lenape Valley Regional High School-Graduated
COMPUTER SKILLS: Windows XP programs: Lotus Notes, Microsoft Word, Excel &
some Power Point.
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