SHAN NANETTE GONZALES

*** **** ***** ****

La Vernia, Texas 78121

Phone: 210-***-****

OBJECTIVE:

Obtain a position that will utilize my knowledge and experience

EMPLOYMENT

**** ** ****ent Risk Solutions Representative/ HEB Grocery Company

Reviews and interprets existing, new or proposed OSHA regulations, updates to department staff is necessary

Investigates and documents hazard reviews; analyzes, evaluates and presents recommendations

Assists managers and supervisors with performance management processes, including planning, monitoring, developing, rating, and rewarding performance

Provides consultation on associated program areas, such as reasonable accommodation and leave management

Coordinates litigation case management to ensure cost containment; attend trials when needed, reports on trial to management, ensures clear and concise communication between defense attorney and management

Communicates with all partners, customers and other third parties who have filed an incident report to determine an appropriate action plan and to provide the best possible customer service

Reviews and evaluates reports of occupational injuries, determine eligibility, and administers any and all benefits due in accordance with the provisions of the Work Injury Benefit Plan

Facilitates subrogation/recovery efforts from third parties responsible Coordinates the effective administration of the Return to Work Program Conducts more intensive investigations for referred cases

Continuously reviews, sets and monitors reserves to reflect appropriate levels of exposure

Reviews and approves payments on all cases within assigned authority

Monitors open claims via diary to ensure regular updates and contact with partner, customer, and vendor

Ensure adequate reserving, communication, and effective resolution on attorney represented or litigated cases

Serves as corporate representative, witness, etc as necessary

2003-2008 Partner Service Center Lead / HEB Grocery Company

Ensures compliance and consistency with HEB company policies, procedures and practices

Supports team of 16 customer service specialists

Responds to questions and assists specialists as needed in resolving issues

Monitors incoming call volume, abandonment rate and availability

Maintains service level agreement by processing benefit, transaction and payroll documentation timely

Monitors team attendance and punctuality

Schedules and deliver training to customer service team

Creates, updates and edits benefit, payroll and transaction training manual

Makes recommendations to streamline current processes to management

Informs benefit providers and vendors of employee enrollments, changes and terminations in electronic format as appropriate

Assists in preparation and distribution of written and verbal communication to inform employees of benefits, compensation, and payroll policies

Coordinates benefit program changes and the annual Open Enrollment process with employees, vendors and internal HRIS and Payroll staff

Proof reads Summary Plan Description when changes occur to ensure accuracy

Maintains relationships, provides advice and guidance to different levels of management, employees, vendors, other entities and agencies, within and outside HEB

Coordinates various leave policies and regulations, including providing information to employees, tracking, documenting, and ensuring appropriate pay status

Processes employee appeals

Processes wage garnishments

Assists with I-9 processing

Assists with weekly payroll

Researches issues and takes appropriate to adjust discrepancies on payroll, benefit, 401K and transactions

Knowledge of FMLA and leave of absence guidelines

Knowledge of healthcare and dependent daycare reimbursement accounts

Liaison between company and insurance vendors

Offers benefits and disability training classes for store and admin locations

Processes 401k transactions to include enrollment, contributions, distributions, loans and hardship withdrawals

Assists with yearly 401K company match process and weekly wire

Knowledge of COBRA rights

Responds to Department of Labor inquiries

Audits transactions per specialist in order to identify training opportunities

2001-2003 Claims Adjuster/ United Healthcare

Answers incoming calls from customers and providers

Verifies benefits and eligibility

Verifies claim status

Processes paper and electronic claims

Processes claim adjustments

Researches company contracts and paid claims accordingly

1999-2001 Provider Relations Associate/ PacifiCare Health Systems

Develops relationships with providers in assigned region

Identifies and research operational issues

Manages provider negotiations and contracts

Researches provider appeals and grievances

Ensures accurate and timely claim processing

Monitors issues with capitation

Ensures provider satisfaction with company

Contact this candidate