Claims Assistant
Resume:
Linda E. Jones
*** *********, ******, **. *****
Email: *********@*****.***
OBJECTIVE: To obtain a position effectively utilize expertise, creative talents and commitment to excellence. Desire a position with a challenging and growth- oriented opportunity.
PROFESSINAL EXPERIENCE
Sedgwick CMS
3760 Kilroy Airport Way, Suite 400
Long Beach, Ca. 90806-2456
Claims Assistant - Professional Liability
February 4, 2014 to March 21, 2019
PRIMARY PURPOSE: To provide technical claims support to the Professional Liability claims staff and customer service to claimants, clients and vendors; to perform administrative duties as required.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Sets up new claim files pursuant to department protocol in IVOS system.
Prepares/Print reports per Client and/or Manager's request.
Handles special mailing and delivery requests.
Issue and process Settlement payments and release forms
Processes claim payments, process refunds/overpayments/void checks as appropriate.
Receive, enter and process Attorney legal voucher payments as requested
Receive and process mail and overnight packages
Performs administrative duties as required.
Performs other duties as assigned.
Gallagher Bassett Services, Inc.
27061 Aliso Creek Road
Aliso Viejo, Ca. 92656
Claims Technician- 12/01/06 to 12/31/12 (Lay-Off)
Assist the Claims Representatives in the set up and administration of Auto, Liability and General Liability and Set up of Workers Compensation claims
Set up and enter new claims into claims management system received via UPS, Mail, Fax and through incoming Claims management system Risx- Facs system
Input and review notes/ diaries in claims management system as instructed
Issue and process settlement payments and release forms
Reviews, prepare, create, and/ or send letters, reports and forms, keep case logs by client, process recovery vouchers and live checks
Assist claims representative with telephone calls and claim diaries
Requesting of Wage Statements, Motor Vehicle Reports
Perform miscellaneous administrative and support functions as designated by supervisor.
Linda E. Jones
129 Remington, Irvine, CA. 92620
Email: *********@*****.***
Pacific Life & Annuity- 04/01/01 to 07/01/05
2300 Main Street, Irvine, Ca 92614
Sr. New Business Specialist (Lay-Off)
Performed a variety of specialized tasks to assist Underwriters and administration of Medical, Dental, Vision and Life Insurance contracts such as Employer Applications, Checks and Enrollment forms
Supported and performed specialized technical skills such as:
Compiled information from brokers, Employers and Applicants and others to prepare packages for Underwriting
Entered census information into system and calculated premiums
Worked with a moderate number of brokers
Handled complex employment packages
Acted as a liaison between underwriters, employers and brokers
Reviewed submitted documents and employer packages to ensure compliance with established regulations, procedures and product requirements
Completed required checklists and worksheets according to policies/procedures
Submitted file for underwriting and reviewed underwriter terms and conditions
Collected conditions from broker and submitted completed file to underwriting
Communicated with underwriters to close files with brokers
Reviewed/ responded to exception reports, audits and quality control reviews
Provided documentation as required
Maintained awareness of all legal regulations related to processing procedures
Performed other related duties as assigned and required.
Software Skills:
PC & Microsoft Office Products ( Word, Outlook, etc.), Windows 08, Lotus Notes, AS400, Solution Suite( Paperless Workstation), SIR, IVOS,
Awards:
Perfect Attendance Award - Pacific Life & Annuity
Reach for the Stars Award - Pacific Life & Annuity
Employee Excellence Award - 2007 & 2010- Gallagher Bassett
REFERENCES UPON REQUEST
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