Benefits Specialist

Veronica Morales

*** **** ** • Wylie, TX *****

Home: 972-***-**** • ********.***********@*****.***

Summary

Diligent, dependable, dedicated,performance-driven insurance professional with extensive experience in client services, employee benefits, and account management. Proven track record of counseling insured parties on all aspects of their benefits solutions. Solid history of the benefit enrollment process. Acknowledged by senior management for advanced interpersonal skills and executing profitable client solutions within the TPA and PEO environments. Expert staff mentor with a talent for fostering effective cross-team collaborations. Fluent in the English and Spanish languages.

Employment History

3/20 - Present

Account Manager Employee

Benefits Higginbotham, McKinney, Texas

Maintains a professional relationship with our clients through exceptional customer service. Assigned to a book of business and responsible for obtaining clients’ trust by meeting their needs and expectations. Account Managers are also responsible for supporting our sales Agent(s) in producing new business and renewing existing business. Serve as an advocate to our clients and their employees through positive relationships with the various carriers and continuous education. Acts as primary contact between client, prospect, agency, and producer; represents the agency in handling complaints, arbitrating disputes, or resolving grievances.

Handles or refers all service requests by our clients. Initiates and Handles marketing of account beginning 120 days prior to renewal date. Gathers the necessary information regarding new/existing accounts and submits this information to the various and appropriate carriers to obtain proposals; investigate carrier products, analyzes and reviews clients’ data to appropriate carriers to recommend appropriate plans and proposals to offer the client. 10/19 - 3/20 Benefits Representative Resourcing Edge, Rockwall, Tex as Ensure the delivery of prime customer service by processing orders and coordinating with other departments to resolve inquiries at a firm providing total benefit solutions through active consulting, administration, and online enrollment services.Follow-up with clients on behalf of a PEO to secure satisfaction with the company's products and services. Resolve customer complaints via phone, email, mail, and social media. Correspond with clientele to verify account information and expedite quality assurance. Oversee sales and customers relationships. Responsible for Annual Renewals, eligibility, all benefit inquiries, enrollments, and all day to day functions of the accounts. Specialized in providing individualized services for life insurance, upgrading existing policies, servicing existing accounts, making presentations, and initiating the claims process for clients.

1/19 - 10/19 Client Coordinator The Plexus Groupe, Dallas, Texas Primarily responsibility is to assist the Client Manager and Client Executive with client questions, proposals, • marketing, rate spread sheeting, sales and service support including claims resolution. Timely respond to Client • Manager and Client Executive requests for information or help. • Key Contributions:ꞏ Handle incoming calls from assigned clients regarding benefit questions, claim issues, eligibility, billing and other • support issues.ꞏ Coordinate with medical and ancillary carriers to ensure the timely resolution of client issues.ꞏ Marketing of cases for existing business renewals and new business, marketing function include gathering census & experience information, plan designs, rates and previous carrier information.ꞏ Review marketing options from carriers and provide plan options, based upon client needs, via a proposal spreadsheet.ꞏ Work with carries to ensure the timely processing of case submissions, work with carriers to ensure ID cards are received by the client in a timely fashion.ꞏ Support Client Manager with enrollment materials, information and presentations for meetings with clients as well as translating marketing documents for presentations.

1/16 - 11/18

Client Services

Representative/Account Manager

Financial Benefits Services, Richardson,

Texas

Ensure the delivery of prime customer service by processing orders and coordinating with other departments to resolve inquiries at a firm providing total benefit solutions through active consulting, administration, and online enrollment services.Follow-up with clients on behalf of a Third-Party Administrator (TPA) to secure satisfaction with the company's products and services. Resolve customer complaints via phone, email, mail, and social media. Correspond with clientele to verify account information and expedite quality assurance. Oversee sales and customers relationship management initiatives. Streamline lead generation and market penetration efforts to develop new • business partnerships. • Key Contributions:ꞏ Collaborate with the technology division regarding research, reports, audits, and exercising damage control for systems difficulties associated with the school district, supplemental benefits, and premium amounts.ꞏ Ex amine and settle client inquiries and grievances, in addition to expediting office duties to meet all deadlines.Mentor and train new personnel.ꞏ Collaborate with the technology division regarding research, reports, audits, and exercising damage control for • systems difficulties associated with the school district, supplemental benefits, and premium amounts.ꞏ Ex amine and settle client inquiries and grievances, in addition to expediting office duties to meet all • deadlines.Mentor and train new personnel.ꞏ Perform as the primary intermediary between school district clients, supplemental insurance carriers, billing coordinator, managerial staff, and the sales department.ꞏ Appointed by senior management to supervise advanced-level claims due to history of efficient case management and satisfactory closure. Served as sole licensed CSR with bilingual skills in English and Spanish when traveling to onsite enrollments, and preparing all enrollment materials in Spanish when applicable. 1/15 - 1/16 Claims Adjuster

Statewide Claims Services, Richardson,

Texas

Investigated, analyzed, and determined the ex tent of the company's liability and initiated settlements with claimants as a representative for a prominent insurance agency in the Texas region.Inspected property damage and personal injury claims to evaluate insurance loss payouts. Interviewed claimants and witnesses and examined all property. Retrieved written and recorded documents and conducted additional research,including reviewing police and surveillance reports and medical documents. Prepared appraisals,gathered data, and submitted details of all claims to the insurer. Verified claim coverage under policy and negotiated with the policyholder on behalf of the insurance company. Analyzed difficult claims for benefit level, third party liability, over payments, and incorrect coding. Directed suspicious claims to the company's investigator.ꞏ Finalized arbitration with third parties to safeguard practical and impartial settlements. Inspected insurance claims to assess the magnitude of the carrier's liability and resolved claims in compliance with policy provisions. 1/14 - 1/15 Injury Claims Associate State Farm Auto, Richardson, Texas Earned promotion in injury claims within 90 days of serving as an ILR Claims Associate In-Language. Expedited injury claims within approved limits for a mutual insurance company servicing over 83M policies and accounts throughout the US.Initiated the claim payment process and streamlined settlement procedures to process high volume claims. Closed files delegated by the Auto Claim Management team, claim specialists, and electronic assignment. Applied knowledge of state and federal laws, statutes, and insurance regulations in claim handling. Procured documented statements and gathered supporting materials consisting of police, surveillance, and medical reports. Routed new and ongoing claims for payment, carrier liability, and denial of benefits in compliance with policy stipulations.ꞏ Performed analysis of claim paperwork to assess Total Loss Settlement potential. Acknowledged by C- level executives with a monetary bonus for optimal client services.

1/13 - 1/14 ILR Claims Associate In-Language State Farm Auto, Richardson, Texas Observed company standards and guidelines to properly review, administer, and settle applicable routine property and material damage claims. Collected initial loss reports from insureds and claimants. Aided clients in choosing rental repair facilities, as well as salvage and towing services. Streamlined data entry for all relevant loss information and distributed the loss reports to the suitable downstream teams.

Education

Diploma, LVN, 8/97

South Texas College, Mcallen,Texas

Areas of Expertise

• Proven ability to exercise good judgement and contribute to efficient operations.

• A high-energy, enthusiastic and dependable individual who excels in challenging and competitive environments.

• Possess a hard-working work ethic in pursuit of excellence.

• Highly effective in negotiation, problem solving and analysis.

• Readily accept new challenges, facing them in a capable and professional manner. Licenses

Texas Life and Health, 6/16 - 3/21

Texas Department of Insurance

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