Experience

Custom Disability Solutions

• United States
• Insurance
• 1 - 100 Employee

• Senior Control de Calidad y Auditoria en Seguros - Compliance Department

  • Oct 2006 - Present

  Performs comprehensive quality reviews:  For Claim functions including STD and LTD Claims, Vocational, Clinical, Admin, Intake, Maintenance, Call Center, and Appeals.  For the assessment, clarification and development of claims management actions and customer interaction.  For determination of eligibility and functionality of claimants applying for and receiving disability benefits. • To measure optimum claim outcomes, quality customer service and financial/data integrity according to department best practice procedures and policy provisions. • To provide suggestions and feedback to Claim Teams and Training Staff for facilitation of claims management, optimum outcomes and training need identification. • To work in conjunction with all Claim Teams and Trainers for continuous quality of claim adjudication improvement. • To randomly audit based on segments which include areas of claim management, customer service and financial/data integrity. • To completed external Client audits and executive reports as appropriate and coordinate internal audits from outside sources (SSAE16, State Dept. audits, etc.) • To perform Performance Guarantees specific to the Client Company treaty or Policyholder agreement. • Assist as needed in other capacities such as Team Leader, Training, Supervisor, Manager, Claim Examiner, company initiatives, etc. Show less



HOOPER HOLMES - MID AMERICA AGENCY SERVICES / MAAS

• Bilingual Underwriting Assistant

  • Jul 2004 - Jul 2006

   All duties related to the underwriting process of individual life insurance policies. Functions performed included, but not limited to:  Processing and review of applications to be issued as other than applied for (decline, postponed, incomplete), including offers of new business quotations for rated applications.  Pre-issue quality control and supervision of underwriting guidelines.  Processing reconsideration requests, order requirements, follow-ups and resolving issues related to life insurance administration.  Excellent bilingual customer service provided to internal and external customers.  Web-based underwriting and workflow system experience. Show less



Rimac Seguros y Reaseguros

• Insurance
• 700 & Above Employee

• Control de Calidad

  • 2001 - 2002

   Development of procedures manual for implementation of Government mandated Auto Insurance Project/ SOAT  Policy administration procedures, duties involved:  Development and design of Insurance Application Form.  Development and implementation of procedures manual.  Quality control of all duties included in procedures.  Supervision and training of personnel.  Development of procedures manual for implementation of Government mandated Auto Insurance Project/ SOAT  Policy administration procedures, duties involved:  Development and design of Insurance Application Form.  Development and implementation of procedures manual.  Quality control of all duties included in procedures.  Supervision and training of personnel.



Santander Group - Corredores de Seguros

• Representante de Cuentas Corporativas - Banco Santander Central Hispano

  • 1999 - 2000

   Negotiated insurance arrangements to sell individual and commercial policies (Property & Casualty) to bank's customers including:  Policy provisions, rates, eligibility, premium administration, and claims management.  Administration of Santander's corporate insurance policies, bankers' insurance policies, and insurance claims.  Supervision claims technicians personnel.  Negotiated insurance arrangements to sell individual and commercial policies (Property & Casualty) to bank's customers including:  Policy provisions, rates, eligibility, premium administration, and claims management.  Administration of Santander's corporate insurance policies, bankers' insurance policies, and insurance claims.  Supervision claims technicians personnel.


RAMIREZ Y CASTILLO S.A. Corredores de Seguros
• Consultora de Beneficios

  • 1985 - 1998