Human Resource Professional who promotes team-oriented human resources and recruiting. Expertise in recruiting and payroll. Highly driven to achieve company goals.
CERTIFICATIONS: All Lines Adjuster License
MS Office Suite
JURIS and SIR,
People soft and Oracle
Project Management Certification
Claims file management processes
Workers' compensation claims
Promoted to claims examiner II within six months of employment.
Worker's Comp Claims Representative IIOct 2013 to Current Company Name － City, State
Manages general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
Approves and processes assigned disability claims, determines benefits due, and manages action plan pursuant to the disability claim or client contract.
Manages subrogation of claims, negotiates settlements, and communicates claim action with claimant and client.
Maintains professional client relationships.
Worker's Comp Claims AssociateJan 2012 to Jan 2013 Company Name － City, State
Evaluate all claim and policy information, investigate all details for insured client for various line of business, and ensure applicable coverage of individual Perform interviews, gather all statements from insured clients, physicians and attorneys for all claim information, and evaluate all facts for policy contracts Investigate and prepare reports for all denials of claims and settlements and provide update on all files and recommend reserve changes to all claims Evaluate progress for all claims, coordinate with team leader for all issues and effective resolution, and develop new methods to handle all claims.
Calculate and assign timely/ appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
Prepare necessary state fillings within statutory limits.
Manage the litigation process; ensure timely and cost effective claims resolution Work within limited authority on assignments of moderate technical complexity.
Review claims to determine liability, secure information, settlement of claims utilizing claims policies and guidelines.
Evaluate claims through contact with insured, claimant, witnesses and experts.
Negotiate settlement as warranted.
Authorize payment within scope of authority.
Data Claims Processing SpecialistJan 2008 to Jan 2012 Company Name － City, State
Proficiently reviewed insurance claims for completeness, including objectively approving and/or denying payments using Mainframe/Next-Gen Ensure high-volume claims accuracy by applying available editing tools to resolve specific claims discrepancies Maintain positive customer relationships and accurately input of all medical billing data in a timely manner Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures Strategically steered research initiatives on claims inquiries and reprocessed claims to guarantee goals were met Recover and retrieve funds from providers, and adjusted provider claims for overpayment / underpayment Build and sustain productive operations by performing research on various projects and major reconciliations.
Human Resource/Business ManagerJan 2007 to Jan 2008 Company Name － City, State
Oversee comprehensive human resources operations Execute pre-screening and face to face interviews Perform background checks and make arrangement for pre-employment drug screens Ensure all applications and pre - hire documents are completed thoroughly and accurately Responsible for providing current recruitment knowledge and trends within the regional market Maximized organizational efficiency by processing and reviewing payroll to ensure 100% compliance with required policies and established laws, along with serving as point-of-contact regarding personnel concerns / problems Work closely with field managers to deliver recruitment needs.
Facilitated contractors agreement with company from award to shelf-life and while ensuring contractors are in compliance with the requirements.
M.B.A, DentonMay 2014Texas Woman TXDenton
B.A, Business Administration, Finance & ManagementMay 2007University of Houston － City, StateBusiness Administration, Finance & Management
Member of National Association of Professional Women
Payroll & Benefits, contracts, human resources, insurance, litigation, medical billing, MS Office Suite, advanced problem-solving, great organizational skills.
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Texas Woman TX
University of Houston
Job Titles Held:
Worker's Comp Claims Representative II
Worker's Comp Claims Associate
Data Claims Processing Specialist
Human Resource/Business Manager
M.B.A , Denton May 2014 B.A , Business Administration, Finance & Management May 2007
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