Claims Specialist Ii Resume Example

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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
Professional Summary
Experienced [Job Title] committed to maintaining cutting edge technical skills and up-to-date industry knowledge.
  • Guest services
  • Inventory control procedures
  • Merchandising expertise
  • Loss prevention
  • Cash register operations
  • Product promotions
Work History
Claims Specialist II, 05/2002 to 02/2005
Mercury Insurance GroupMO, ,
  • Reviewed Caner and Accident claims to include processing claims; paying, denying, and pending of a claim based on information submitted for review.
  • Analyze billings and supporting medial documentation and use an in-house claims processing system that includes subsystems for diagnosis and procedures to determine nature and validity of claim, leading to the determination of liability and direction of claim after thorough review of all submitted documentation and verification of policy provisions.
  • Communicate effectively, orally, and in writing, in handling the initial processing and follow-up of claims or in responding to inquiries from insured's, providers, agents, and attorneys regarding the claim status and policy provisions.

Human Resources Benefits Administrator, 02/2005 to 03/2007
Blue Hills BankMilford, ,
• I was responsible for several insurance departments. I was the single point of contact for Short Term Life Insurance, Whole Life Insurance, Aflac Supplemental Insurance, Short Term Disability, and Long Term Disability. I planned, organized, and directed the activities related to the Insurance programs I was responsible for. I made sure that I reviewed and assured compliance with Federal Statutes as it affects employee benefits. I developed employee benefit procedures, programs, and spread sheets. I oversaw the maintenance of employee benefits records through on-line data terminal/work station computer input. I developed procedures and forms whereby district and school-based personnel can add to, delete from, or update the employee benefits master file. I coordinated workflow and procedures between employee benefits and other departments. I was the acting liaison between employee benefits and other departments and schools. I was also the acting liaison between all the Life, Supplemental, and Disability plan representatives. I was responsible for developing and maintaining a system of procedures to administer the employee benefits program. I was in charge of coordinating the acquisition of Life, Supplemental, and Disability Insurance coverage benefit programs. I was in charge of monitoring and reviewing performance agreements with all plan providers. I also prepared special reports and records as needed for all organizations. • I was solely in charge of developing and projecting premium deduction schedules on a monthly basis for the purpose of reduction/deduction for monthly premium remittance to all benefit plan companies for all employees. I prepared deduction and contribution reports for each payroll which included a monthly payroll, and two separate bi-weekly payrolls. It was my responsibility to monitor the deductions and payments of benefits from all employees payroll to include set up of deduction, issuing credits, and termination of payment for benefits. It was also my responsibility to monitor all payrolls and issue letters to those employees that were on leave of absence and their premiums were not deducted. I was in charge of reconciliation of five monthly premium reports, correcting any discrepancies, and issuing payment to the companies involved. I also monitored monthly plan eligibility reports. • I coordinated training of district office and school based personnel in the understanding and utilization of employee benefits information. I developed and prepared communication and education materials regarding the benefits package for all the insured employees. These materials included creating forms for the insurance companies involved for our employees to fill out, creating slide show presentations on Microsoft PowerPoint, and hosting weekly New Employee Orientations. • I was in charge of preparing all inventory and invoices for the benefits department. I put together all cash vouchers and was in charge of making the deposits. I would assign priorities and deadlines to the staff. I was solely responsible for maintain office supplies and making orders. I perform my job responsibilities with minimal to no supervision.
Test and Evaluation Specialist/ Database Manager, 11/2009 to 04/2011
AbmKyle, ,
I support the planning, observation, and setup of tests in all venues including laboratory and field tests. I have knowledge of technical material and the ability to train and supervise others. I am in charge of supervising and monitoring the Data Entry Clerks. I perform my job responsibilities with minimal to no supervision. • I have extensive knowledge in data analysis reporting and supporting documentation. I am capable of high volume data entry. I collect and evaluate statistical data or reports to identify agency/program performance trends. I also gather and maintain specified records of engineering data such as tests, drawings, etc. I am very proficient with basic-to-intermediate spread sheet functions. I solely design, secure, implement, and maintain supported database management systems. I organize and tabulate the data using a variety of techniques including database software spread sheets, statistical tables, charts and graphs issues. I am able to plot data and create graphs for review. I also perform computations by substituting numbers in specified formulas. • I organize materials and complete writing assignments according to set standards regarding order, clarity, conciseness, style, and terminology. I review published materials and recommend revisions or changes in scope, format, content, and methods of reproduction and binding. I also perform general clerical duties to include but not limited to: photocopying, scanning, faxing, mailing, and filing. I answer telephones and transfer to appropriate staff members. I create and modify documents using Microsoft Office. I maintain hard copies and electronic filing systems. I set up and coordinate meetings and conferences. I support the staff in assigned project based work.
Account manager, Office Manager, and Executive Assistant, 02/2010 to 07/2015
Imperial RenovationsCity, ,
Maintain all appointments and schedule for staff. Responsible for accounts receivable and payables. Preparing payroll and monitoring expenses. Received and screened all phone calls and emails. Maintained all office services and functions. Extensive use of QuickBooks in Excel, among other computer-related programs.
Accounts Receivalbe/Online Portal Data Base Manager, 09/2015 to 04/2016
Parks CoffeeCity, ,
Keep track and process accounts and incoming payments in compliance with financial policies and procedures. • Perform day to day financial transactions including verifying, classifying, computing, posting and recording accounts receivable data. • Reconcile the accounts receivable ledger to ensure that all payments are accounted for and properly posted. • Facilitate swift payment of invoices due to the organization by sending bill reminders and contacting clients with outstanding accounts. • Generate financial statements and reports detailing accounts receivable status. • Research and assist with customer's disputes and issues. • Set up and maintain customer's online portal 3rd party payment systems. • Assist Accounts Receivable manager with end of year closures and other duties.
Payroll Manager, 05/2016 to 02/2017
Responsible for payroll for 210 subway locations as well as about 25 Message Envys across Texas every week to include data entry. Responsible for new hire packets and maintaining APD Workforce and Quick Books. Reconciliation of multiple credit cards and multiple bank accounts. Review commercial leases for the locations. Health insurance for the company. Along with other duties such as payroll deductions, exit forms, raise forms, Child Support, WOTC,EEOC, employment verification, and accounting to include payables for all locations. Ensure that our company adheres to the labor laws.
Bachelor of Science: Computer Science, Expected in Current
Columbus State University - Columbus GA,
Associate of Science: General Studies, Expected in 2014
Georgia Military College - Columbus GA,

Life and Health Insurance

Secret Government security clearance

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Resume Overview

School Attended
  • Columbus State University
  • Georgia Military College
Job Titles Held:
  • Claims Specialist II
  • Human Resources Benefits Administrator
  • Test and Evaluation Specialist/ Database Manager
  • Account manager, Office Manager, and Executive Assistant
  • Accounts Receivalbe/Online Portal Data Base Manager
  • Payroll Manager
  • Bachelor of Science
  • Associate of Science

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