Dedicated Account Claims Examiner
Resume:
EMA ROSALES
Skills Summary
An organized, creative and ethical individual currently looking for a position with an organization, where I can utilize my existing knowledge of claims handling and further perfect them.
Education
University of Bucharest
School of Journalism and Communications Science
Certificates:
SIP – issued on 08/31/2023
Degree / Date of Graduation
Bachelor’s in Public Relations / July 2012 – attested by the European Union, with the Sorbonne stamp
Experience
Tristar Risk Management
Indemnity Claims Examiner II 01/01/2022 through current (dedicated account)
Currently handling a 125 caseload of indemnity claims for a dedicated account. Cases vary from TD, Minor PD, and larger exposures of up to total incurred of $300,000.00.
Maintaining audit scores at 94% and over.
Received 2 years in a row the President’s Award for Outstanding Performance.
Maintaining great customer service while always operating within the Best Practices Guidelines of the company and the Client’s Special Handling Instructions.
Actively pursuing resolution of all claims, by being proactive, employing nurse case manager services and/or legal counseling.
Claims Examiner Medical only 11/17/2020-12/31/2021
Handled all Medical only claims on a dedicated account, keeping at all times an active 120 case load, with a monthly closure rate of about 30 claims.
Broadspire, a Crawford and Crawford Company
Claims assistant/ Medical only examiner 05/2018 to 05/02/2020
As a claims assistant in worker’s’ compensation insurance field, my duties range from drafting and sending to the appropriate parties state letters regarding acceptance or denial of claim, temporary or permanent disability benefits, rate change of benefits and delays, issue payments for settlements or past due accounts to successfully assisting the resolving of claim through settlement.
Also, I assist the team in the preparation of needed documents for med-legal appointments, set the med-legal appointments, send out appropriate notifications of the appointment to the involved parties, set up transportation and translation services for injured workers, if needed.
I also help the team with translations from Spanish and over the phone translations when contacted by a Spanish speaking injured workers.
Lexitas Legal
Legal office consultant 04/2017 – 05/2018
Lexitas Legal is a copy service providing the insurance company Broadspire of Crawford Company with document retrieval for subpoenas in workmen’s comp matters. My duties consist of following the procedure of releasing legal documents requested through subpoena(following HIPAA guidelines), contacting the requesting party regarding status of their document retrieval and performing legal consulting, on site, work for workmen’s comp claim adjusters.
Rosales Concessions
Manager -Aug 2012 – Sept 2017
For Rosales Concessions, which operates at special events such as fairs, expos, fundraisers, my duties consisted of:
Posting ads for hiring novice or experienced personnel, I have the task of firing existing employees
basic accounting ( paychecks and advances, rent, distributors bills, balancing ledgers) and basic auditing ( keep track of all cash registers, program them, check the tapes every night, write down a daily situation for each cash register including a starting and ending z )
Training new personnel in all food stands, working inside the food stands during prime time and under staffed periods
Checking all inventory lists, purchasing stock, ordering stock from distributors we have been using for years, renting equipment, such as refrigerator trucks, ahead of time
Maintaining and creating new relationships with distributors, fair boards, event organizers
Every week be present for a walk around with the health and fire inspectors; every six months contacting a certified company to service all fire protection systems and fire extinguishers
Keeping track of all paperwork and necessary updates for the commercial vehicles used to move the equipment (registrations, smogs)
Skills
Microsoft Office: Word, Excel, PowerPoint, outlook
Fluent in English, Spanish and Romanian
Conversational skills in French
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