Beverly A. Jorges

**** *. ***** ****, ********* Heights IL 60004

224-***-**** ad3c0t@r.postjobfree.com

Objective

Experienced administrative professional with excellent written and communication skills. Demonstrated ability to work under pressure while handling various tasks. Fully bilingual

English and Spanish. Proficient in Windows XP/2k, MS Office Word, Excel, Power-

Point, Outlook and Internet search engines.

Outlook and Internet search engines.

Experience

5/2021- Present Proman Staffing Agency Northbrook, IL

Claims Administrator II

Provide assistance with claims reporting and support services for workers compensation claims.

Review claims submissions and determine eligibility and level of coverage

Provide assistance with claims reporting and support services for Workers Compensation claims.

Provide assistance with claims reporting and support services for workers compensation claims.

Provide administrative support for Risk Management

Help manage the employee return to work and medical case management programs.

Assign new claims to the appropriate claims examiner based on predetermined criteria.

Respond to all emal and phone inquiries within 24 hours

4/2014- 4/2021 Granite Construction Company Northbrook, IL

Safety and Claims Administrator II

Administer, direct and manage compliance with the company safety program and local accident prevention efforts to ensure company safety goals are met. This includes the authority and ability to change and/or adjust work procedures as may be required to ensure the safety of affected employees and the general public. Directly responsible for all new hire safety orientation, training and all drug screening requirements.

Support the Group Safety manager including scheduling meetings, maintaining calendar and travel arrangements.

Develop, organize and implement safety related programs that meet or exceed company safety standards. This includes the ability to make independent judgments concerning the general safety of our work.

Initiate perform and document jobsite inspections and audits with special emphasis on hazard recognition, unsafe behaviors and correction of potential third party, asset loss and workers compensation losses. This necessitates the ability to think independently, communicate thoroughly and facilitate the implementation of corrections/behaviors. Have performed safety site visit and walk downs

Initiate coordinate and conduct safety meetings and training programs to ensure the effective communication of company policy and safety standards. Coordinate and participate in regulatory agency inspections and investigations to ensure compliance with federal and state regulations.

Coordinate and control the development and review of job hazard analysis for each major phase of our work to ensure its safe completion. This includes assessing the need for and facilitating the training for each JHA as may be required.

Investigate, prepare and maintain a record of all third party, asset loss and workers compensation claim to make certain that the interests of the company are preserved. Follow up with the corporate insurance department as regards insurance claims, to ensure that documentary information has been collected, secured, and preserved so that claims will be resolved in a timely manner. As may be required at the local office, this includes the authority and ability to represent and/or negotiate the settlement of certain loss related claims.

Ability to consistently act with integrity and credibility, by abiding by and enforcing Granite’s Code of Conduct on a daily basis.

2/2012 to 2014 Sedgwick CMS Chicago, IL

LTD Claims Manager II

Analyzes assigned claims and determines benefits due.

Informs claimants of documentation required to process their claim and timeframes.

Manages claim to ensure compliance with plan provisions.

Provides appropriate documentation to LTD Manager for reporting purposes.

Determines need for outside vendors, surveillance and/or independent medical evaluations as required and seeks advice from management, as necessary.

Refers cases to LTD Supervisor, LTD Manager, or Project Manager.

Negotiates settlement of appropriate claims within designated authority level.

Makes claim payments and revisions to benefit amounts.

Communicates status on decisions to client, claimant and supervisor.

Calculates and collects overpayments.

Supports the organization's quality program(s).

8/2010 to 2/2012 Dearborn National Downers Grove, IL

STD Claims Adjuster II

Assumes responsibility for all assigned large accounts and sensitive groups to review and resolve customer problems and complaints concerning claims matters and personally handles the claim through resolution

Relieves and completes work assignments for other Claim Representatives during absences, etc. to stay within the unit's established turnaround schedule.

Investigates, researches, verifies and obtains medical information on all claim types to determine eligibility and interpret information relating to the severity of the stated disability.

Adjudicates claims in accordance with established policies and procedures

Interviews, telephones and/or corresponds with customers to determine extent of customer concern and resolves situation in accordance with standard operating procedures.

Obtains complete and accurate information from groups, agencies, physicians, claimants, etc., to verify and ensure claim eligibility and/or continued disability

Maintains thorough knowledge of all policies, statues and regulations, medical conditions and departmental procedures to ensure proper dispositions of claims

Recommends changes to management to avoid reoccurring customer inquiries/problems.

Adheres to quality, production and departmental guidelines to process claims

Provides professional, prompt and accurate customer service via telephone and in writing to members, groups, doctors, etc., in handling disability and EIB claims.

Approves or denies claims within policy limits; recommend approval, denial, rescission or settlement of disputed claims.

10/2007 to 5/2010 Protective Life Insurance Bannockburn, IL

Claims Adjuster

Review submitted claims and pending claims, establish new claims in the system, and make additional required document request by letter or telephones

Accurately calculate GAP claim payments and complete payment to the lender

Answer claim related questions via telephone in English or Spanish in a prompt, professional manner

Conduct necessary research to resolve claim issues brought by lenders and internal/external customers.

Gap Claims approval of $3200

07/2006 to 10/2007 HSBC Wood Dale, IL

Yamaha Merchant Representative

Answer all Yamaha Merchant telephone calls

Processed HBMT, Final Sort

Funded sales manually, created and closed exceptions

Assisted with revolving credit customer services calls

Promotion corrections, corrected funding issues such as credits, rejects and overpayments.

Assisted with FDI to release and input title information into system.

Promoted to:

Powersports Insurance Representative Wood Dale, IL

Handle all powersports gap claims ensuring they are worked on in a timely manner by preparing and setting up claims.

Letters of Guarantee, posting insurance payments to accounts to settle gap claims

Issue payment histories as requested by gap insurance companies, release titles to insurance companies in a timely manner,

Assist in training new employees, assist with gap and claims customer service calls for closed end and revolving accounts.

Assist in Yamaha Merchant Services

10/2004 to 7/2006 Home Warranty of America Buffalo Grove, IL

Customer Service Call Center Claims Adjuster

Answer heavy volume claims and customer service telephone calls.

Review and approve all claims.

Handle all Spanish claims for adjusting.

Vendor leads

5/2002 to 8/2004 Bonneville School San Juan, PR

Administrative Assistant

Travel arrangements handle confidential files for students and teachers, screen applications for hiring new staff, telephone interviews for future job candidates, setting up staff meetings.

Administer students records such as register attendance, grades and check that all comply with the Department of Education vaccination requirements

Coordinate student’s enrollment and tuition, Schedule parent/teacher conference

Substitute teachers and tutor student when needed, other general office duties

7/1997 to 4/2002 AON/Combined Insurance Chicago, IL

Claims Customer Service Call Center

Met and surpassed daily rate of 100 calls for the Claims and Customer Service Call Center.

Handled all of Puerto Rico Claims and Customer Service Calls

Handled Life, Accidental and Dismemberment policy claims, and death claims, adjusted Health and Accidental Claims. Handled payments and collection calls.

1/1995 to 6/1997 Bankers Life & Casualty Chicago, IL

Customer Service Representative Call Center

Handled all Medicare, Life, Accident and sickness supplement calls for claims and benefits.

Agent reports

Letter writing and follow ups.

Education

2004 Universidad Metropolitana, San Juan, PR

Associates in Education in progress

1989-1990 Northwestern Business College

Associates in Business in process

Osha 30

First Aid/CPR

Knowledge, skills, and abilities

Knowledge of Fall Protection and MUTCD standards, and DOT regulations.

Extensive knowledge of Construction Safety Orders.

Working knowledge of OSHA, MSHA and other state and federal agency guidelines.

Excellent communication, presentation, and interpersonal skills.

Ability to teach, mentor and lead.

Ability to work in high production environment (50+ hours/week, including nights and weekends are expected) and respond quickly and effectively under pressure and deadlines.

Ability to make independent judgments to manage and facilitate company programs/policies as they relate to the safety of our work.

Diploma

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