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Sr. Claims Representative Resume

Union City, CA

PROFESSIONAL EXPERIENCE:

Sr. Claims Representative

Confidential, Union City, CA

Responsibilities:

  • Conduct investigations on all types of assigned claims; obtain statements, confirm coverage, establish damages, determine liability, report status, and negotiate settlements.
  • Contact claimants, agents, witnesses, police and fire departments, attorneys, and all other persons incident to the investigation and processing of claims
  • Make payment of assigned claims within prescribed limits of authority
  • Inspect damaged property and vehicles to determine claims related damage
  • Determine and report on subrogation potential; prepare for arbitration
  • Report theft, fraud, and arson losses as required to state and industry agencies
  • Represent Farmers from a public relations standpoint as a member of management at all times

Supervisor

Confidential, South SF, CA

Responsibilities:

  • Manage the daily Confidential Access to Care Foundation team operations by performing ongoing reporting and analysis in Salesforce CMS, including inventory tracking, phone volume, and KPIs
  • Lead and manage multiple product launches ensuring accountability for project timelines
  • Establish and enforce performance standards by providing coaching and feedback to a team of 15+ direct reports and individual contributors; conduct evaluations, case reviews, and call monitoring
  • Maintain timely and effective communication with management regarding departmental issues
  • Assist in the hiring and on - boarding of full-time employees and contractor staff
  • Collaborate with cross-functional business partners to assist with requirements gathering, business process design, and end-user functional testing for system enhancements and upgrades

Foundation Specialist

Confidential, South SF, CA

Responsibilities:

  • Lead and support Confidential cross-portfolio product launches and actively work with peers, supervisors, and Access Solutions partners to discuss processes, policies, issues, and guidelines
  • Manage individual patient cases in Salesforce CMS to provide access to therapies for qualified patients while maintaining the highest compliance standards and exceptional customer service
  • Contact patients and healthcare providers to obtain documents required for patient application submission and eligibility determination processes
  • Coordinate delivery of Confidential product to patient or physician, following all patient assistance program guidelines and policies, ensuring compliance with local and international reporting of adverse events
  • Support the home base training team as a new-hire preceptor and product trainer
  • Serve as the Confidential Access to Care Foundation Compliance Captain, assisting self-monitoring and self-auditing initiatives to reduce risks in processes and ensure ongoing compliance, address audit and case review findings immediately, and implement plan to decrease future findings

Business Analyst

Confidential, Walnut Creek, CA

Responsibilities:

  • Lead the analysis, design, development, and delivery of the Confidential Enterprise Practice Management and Electronic Health Record applications
  • Build and maintain all business and clinical application functionalities including tables, templates, demographics, new location set up, and security hierarchy
  • Support product implementation of all system software upgrades and enhancements
  • Independently manage multiple projects in compliance with definitions of project scope, timelines, and deliverables, providing status reports to clients and project team
  • Interact directly with physicians and clinic practice staff to provide on-site Go-Live support
  • Perform workflow assessments and recommend alternatives, including patient flow and billing analysis
  • Identify, document, and track status of application issues within the software and knowledge-base

Business Application Coordinator

Confidential, Oakland, CA

Responsibilities:

  • Analyze business processes and functional requirements, develop business cases, and provide client support during Epic system development and product implementation 
  • Assist in data collection, report details, interpretation and documentation of load work sheets associated with the use of EpicCare Ambulatory application
  • Perform in-depth analysis and documentation of department workflows
  • Provide training and on-going support during all phases of implementation
  • Monitor functional components of system for operations, data quality, integrity, and efficiency
  • Perform application testing, system configuration, and implementation of upgrades and enhancements

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