Manager Customer Service

Nick E. Chavez, Jr.

**** ****** ** ******* **** 505-***-****

Santa Fe, NM 87505 email *************@*****.***

Experience:

Insurance background

Risk Management

Life, Health, Property and Casualty Licensed

State Licensed Independent Multi-Line Adjuster

Workers Compensation

Tort Claims

Employment Liability Claims

Civil Rights Claims

Law Enforcement Claims

Medical Malpractice

Employment:

State of New Mexico Santa Fe, NM

GSD/Risk Management Division 12/17 to Present

Claims Adjuster Advanced

Investigate and adjudicate Tort Claims, property casualty, auto liability, auto physical damage, medical malpractice, civil, law enforcement and general liability claims

Mentored and trained new and existing employees in property and casualty and work comp best practices

Partnered with legal defense to minimize exposure and push for settlement

Patriot Risk Services Albuquerque, NM

Senior Claims Adjuster 01/16 to 01/18

Investigate and adjudicate property and casualty and workers compensation claims for NM, OK, SD

Assisted pharmacy benefit program manager with formulary and dispensing protocols

Assisted clients with safety training and occupational health education to minimize claims exposure

Partnered with clients to report OSHA and workers compensation claims

Participated in creating blueprint for pharmacy peer review services to analyze narcotic utilization

York Risk Services Group Albuquerque, NM

Senior Claims Adjuster 01/15 to 01/16

Adjudicated and resolved both small and large loss Workers Compensation claims

Reported status update, including reporting losses to corporate entities, including out of State contacts

Christus St Vincent Hospital Santa Fe, NM

Certified Pharmacy Technician 10/03 to 10/13

Specialty Compounding of IV admixtures

Training and mentoring of new staff in retail department and clean room processes

Assisted Human Resources in developing training classes and course curriculum for new hires

Administered follow up assessment to analyze impact of training materials

Classroom teaching and orientation of new hires

Certified IV Pharmacy Technician

Collaborated with Healthcare and Risk Management staff to ensure compliance with new Hospital, Governmental Agency and New Mexico Board of Pharmacy regulations

Developed tracking system to monitor New Mexico Board of Pharmacy and PTCB expirations to ensure compliance with licensure requirements

New Mexico Self Insurers’ Fund Santa Fe, NM

Claims Examiner 12/05 to 06/13

Adjudicated and resolved General/Auto Liability, Bodily Injury and Workers Compensation claims, including catastrophic and death claims

Marketed insurance products and services to obtain new book of business

Partnered with Reinsurer, pharmacy benefits manager and legal counsel to successfully close and resolve claims

Zurich Insurance North America Dallas, TX

Claims Adjuster/Claims Consultant Santa Fe, NM

01/03 to 05/03

01/05 to 12/05

Consulted successfully with employers and health care providers in transitioning claimants back to work

Provided marketing and sales presentations to NM Insurance Brokers and Agents to develop and promote line of business in the Southwest

State of New Mexico Santa Fe, NM

GSD/Risk Management Division 05/03 to 12/04

Human Services Department

Division of Vocational Rehabilitation

Disability Claims Manager/Management Analyst

Analyzed Short Term Disability and Long Term Disability claims to determine eligibility and coverage for payment according to the State Disability Plan

Provided pharmacy benefit training and education to clients and insurance group representatives across the State of New Mexico

Reduced overall State of New Mexico reserves by 8 million dollars

Provided Marketing and Outreach to clients, State and Federal agencies and report on Legislative Session Bills

CIGNA Group Insurance/Integrated Care Albuquerque, NM &

Case Manager/Certified Pharmacy Technician/Insurance Adjuster Dallas, TX

04/91 to 01/02

Adjudicated Short Term and Long Term disability claims

Provided training and support for staff education and certification in HIPAA, Pharmaceutical and ERISA regulations

Supervised 6 to 15 customer service representatives -- ensuring excellent Customer Service, efficiency and work flow

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