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Fund Manager Claims Adjuster

Location:
Saint John, IN
Posted:
October 12, 2021

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Resume:

Dalila Lira

773-***-****

*** ****** ** **********, ** 46385 ado0gf@r.postjobfree.com

Valparaiso University January 2017 - Current

Human Resource Administrator Valparaiso, In

● Serves as the front line HR service provider for the University's employees, visitors, and job applicants.

● Processing of new hire requests and support the Position Review Committee.

● Administer employment application and onboarding systems such as Open Hire and Red Carpet.

● Prepare and publish open position postings on both internal system and appropriate external job boards.

● Facilitates background checks and I-9 verifications consistent with regulatory requirements.

● Prepares employment offer and appointment letters for new hires.

● Maintains and updates the Office of Human Resource Services web pages.

● Prepares and distributes department communications through the EMMA system.

● Works collaboratively with payroll office to provide relevant data affecting employee pay (direct deposit, tax forms, etc.)

● Supervises and assigns job tasks to student-employees. Local 25 SEIU Welfare and Pension Fund March 1999 – December 2016 Local 25 SEIU & Participating Employers Pension Trust Chicago, IL 60601 Contributions Processor

● Process reports for over 25 thousand members who work in the Chicagoland and Suburban area.

● Allocate monies for Welfare and Pension Funds accordingly.

● Send adjusted reports for over and under payments to employers.

● Review and update all Payroll Audits.

● Send retro bill for missing payments for insurance and pension benefits.

● Interact with members and employers regarding insurance issues and delinquency issues.

● Prepare monthly billings for mailing.

● Advise members of Health Benefits and Eligibility. Claims Adjuster

● Spanish translator for Claim Appeals, correspondence, all phone calls, and any walk-in’s.

● Process Health Care and Disability Claims.

● Investigate claims for eligibility for in and out of network.

● Inform Health Care Providers and hospitals to coordinate benefits and negotiate claims.

● Maintained Claim records, referrals and all archived documents.

● Adjust pending claims for all Accelerated Therapy bills.

● Verify Eligibility and Claim status on participants for hospitals as well as their dependents. Collections Specialist/ Contributions

● Collect past due unpaid Welfare Contributions from Union Contractors by mail, fax or phone.

● Explain to Union Employers how to contribute for late fees accumulated due to late submissions.

● Direct contact with Attorney for delinquent employers.

● Monitor timely receipts of installment settlement agreements.

● Prepare files for Payroll Audits submitted to Fund Manager.

● Aid Union Representatives with any information provided by Employers.

● Data entry processing employer reports and create a Cash Sheet (from Excel)for Daily Deposits from Bank. Pension Consultant

● Assist in the administration of the pension trust fund for 20,000 members and 5,000 retirees estimated.

● Prepare, process and Authorize members pension benefits including death benefits for beneficiaries and disability benefits.

● Research and calculate member pension eligibility.

● Assist Pension Trust Fund Attorney on legal discrepancies.

● Prepare annual 1099R tax forms, 70 notifications, SSA notifications for vested benefits and other forms. Member Services

● Request identification cards for insured recipients

● Provide medical benefits for eligible participants and their dependents

● Verify Eligibility to participating clinics, both medical and dental

● Send correspondence regarding insurance coverage

● Translation of documents from English to Spanish and visa versa

● Travel to union onsite meetings to explain benefits of insurance Education

Robert Morris College- Chicago, IL - Associates Degree in Business 1996-1999 Skills

● Detail oriented and have strong organizational skills.

● Customer focused and able to work in a collaborative environment.

● Exhibit a high degree of professionalism and able to maintain confidentiality

● Proficient in Microsoft Word, Excel, Outlook, Datatel

● Fluent in Spanish reading, writing and translations

● Certified Notary Public



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