Experience

Beaches Insurance Pty Ltd

• Australia
• Insurance
• 1 - 100 Employee

• Accounts Administration Specialist

  • Aug 2021 - Present



QBE Insurance

• Australia
• Insurance
• 700 & Above Employee

• Property Loss Adjusting Support Officer (II)

  • Sep 2013 - Feb 2021

  PROPERTY CLAIMS - Farm Pack Insurance - Homeowners Insurance - Business Pack - Landlord Insurance - Liability Insurance - Business Interruption Property Loss Adjusting Support Officer (II) - Admin Task - Allocate new instructions to internal adjusters within SLA - Creating Report of Loss - Lodge a new claim on request of an adjuster - Prepare ALL Payments & Claim Reserve Estimates change requests - Notify, create and transferring completed claims for Recoveries - Obtaining Police Reports in Australia - Referral to Investigation Team for possible fraud - Run off ‘handover’ adjuster files through to completion. This includes however is not limited to obtaining updates from builders/providers, maintain customer contact, chasing of invoices, invoice payments, & checking for outstanding invoices. - Answering phone calls from builders, suppliers, customer or adjusters to provide updates/support as required. - Allocation CAT Claims to Quality Repair Managers onshore. - Review and allocation of Fair & Reasonable and Variation RequestsSpecial Projects: - Paying outstanding builder’s fee and System fees invoices through PropertyLink System- Paying Sedgwick fee invoices quarterly in all Property Claims

• Claims Analyst Officer (I)

  • May 2013 - Feb 2021

  2013-05 - 2021-02 Claims Analyst Officer (I) QBE Insurance Group Shared Services Centre (Australian Operations) Netcube Bldg, Bonifacio Global City - Lodging claims through emails and over the phone. - Processing end to end claims from lodgment up until closing, finalization and settlement - Making payments within assigned delegated authority - Managing rejected, missing and hold payments by Bank Reconciliation - Interpret Policy Wording and Policy Schedule - Referring back to Policy Services Dept and Underwriting for policy wording verification - Contacting the insured/ broker for supporting documents needed - Assigning an adjuster for further site assessment - Assigning builders, suppliers and restorers for claim completion - Liaise with Crawford and Sedgwick for Adjuster’s Report - Monitoring of Diaries for All Property Claims System - Creating Partial/ Full Decline Letters with approvals from onshore - Chasing 3rd parties for Recovery purposes



TeleTech

• Denmark
• Appliances, Electrical, and Electronics Manufacturing

• Provider Service Advisor for Member Claims (TIER II)

  • Sep 2010 - Mar 2013

  2010-09 - 2013-03 Provider Service Advisor for Member Claims Tier II BLUE SHIELD OF CALIFORNIA HEALTH CARE ACCOUNT TELETECH ROXAS, Pasay City - Providing eligibility information to insured if they are covered for a certain medical service. - Quoting how the claim was priced and processed by Blue Shield. - Reviewing claims if it was processed correctly based on Insured’s policy - Advising Insured their type of policy and premiums dues. - Advising if Individual or Family Deductible has been met - Advising how much would be the patient’s responsibility ( co-payment or co-insurance) - Informing Insured if a certain medical procedure would require authorization from Personal Care Physician or Blue Shield’s Medical Management - Informing Insured regarding number of sessions or visits they have for a therapy or medical service - Sending Explanation of Benefits(EOB) to Insured/ Provider - Researching Blue Shield’s allowed amount for medical procedure codes - Filing appeals and grievances in behalf of the insured. - Checking for medical records received in the system - Deals with Pharmacy Services regarding member’s Prescription Benefits - Dealing with billing hospitals and Insurance Dept for professional and facility claims. - Deals with Collection Agencies in US - Changing Insured’s Personal Care Physician - Adjusting claims manually. - VIP Processing for Priority and Standard Claim Cases - Rebatching and forwarding claims and correspondence for activation purposes. - Requesting Microfiche processing for purged claims. - Filing a privacy or incidental reports - Forwarding claims to Lodi Team in California for claim adjustments. - Reviewing claims for possible expedite cases.