Jacqueline Frias
Kissimmee
Summary
Over 13 years of experience working in the Worker’s compensation field. Spanish Interpreter-Translation of Legal documents; assist in translation between injured workers and Claims Managers. Addressing questions and concerns of medical providers.
Overview
26
26
years of professional experience
Work History
Claims Support Coordinator/Interpreter
Synergy Comp Insurance Co
04.2018 - 05.2026
- Complete Spanish Speaking Injured Worker’s questionnaire.
- Process any and all new claims within 4 hours of receipt free of errors; attach any documents received via fax, email within 24 hours of receipt; complete requested task which included but not limited to claims manager’s request and issuing Bureau Documents with 24 hours of receipt and file diaries within given due date. As well as following up on all outstanding items needed within 24 hours that restrict a diary being completed and properly documentation of actions taken to claim file.
- Process all W9 request 24 hours of request. Uphold integrity of all entities in Riskmaster by processing through Convey (evaluated monthly with 1099 Report).
- Provide excellent customer service to all parties (internal and external) in all methods of communication including phone, email or in person. Specifically, following up and responding to all VMs or email messages within 24-48 hours of receipt, depending level of urgency/priority.
- New business on-boarding-complete assigned on boarding tasks in outlined time frames to ensure a successful and professional on-boarding experience for all new accounts (includes but not limited to: obtaining industry specific codes, facilitating creation of panels, on-boarding with vendors, creating state specific claim reporting packet and distributing contact information to company).
- Facilitate Panel Updates-Serve as liaison to facilitate the creation of and updates to physician panels for fully insureds; communicating timely with our vendor, the handling claims manager, and the insured to ensure that all parties are aware of any changes.
- Pull document and distribute to appropriate parties all Bureau Correspondence from WCAIS daily.
- Process all outstanding bills in the “Medical Index through Rising Medical Solutions.
- Attached all expense bills to the appropriate claim file.
- Create new policies and org. hierarchy for any new or renewal business within 48 hours of receipt of Business Order or by time of effective date if less than 48 hours. Also responsible to maintain any Special Handling notes in policy.
- Maintenance of Claims Services Validation report, Policy Null, and MBR; making corrections timely.
- Pull TPA losses as needed; also distribute Monthly Dashboards for each TPA accounts.
- Review and update 1099 report received from accounting.
Synergy Comp Insurance Company
11.2012 - 04.2018
- Handle all claims medical and Indemnity claims from beginning to end.
- Participate in a daily huddle with team lead reviewing code reds, closure, diary review, new claim activity and what needs focused on for the day. Review daily phase1 &2 report first thing each morning. Follow up and document all activity to resolve indemnity exposure.
- Maintain Average Lost time claim duration at KPI goal or less.
- Maintain average restricted day duration at KPI goal or less.
- Maintain average of litigated claims at KPI goal or less.
- Account Management-attend and participate in pre-executive reviews, pre-proposal meetings as well as attend any necessary hearings
- Review of reports to monitor lag time/trends
- Completing UW Alerts ad Account Scorecards as needed
- Maintain closing ratio at 95% or higher
- Maintain target of diary completion
- Maintain close handle on and follow up on Large Loss Claims
- Timely notification of Claim Petitions/Litigation Notices to in house counsel. Work with in-house counsel to strategize handling of litigated files with ultimate goal of mitigation ongoing exposure, as well as managing legal and expense costs. Participate in quarterly litigation claim reviews with in-house counsel and panel counsel.
Six Grade Teacher
Immaculate Conception School
01.2000 - 01.2009
- Develop curriculum to meet developmental goals and instructional activities.
- Prepare lesson materials, grade papers, manage the classroom, and evaluate and give feedback to students
- Exercise open and respectful communication with families, coworkers, supervisors, and other school staff
- Measure progress and accomplishments of students towards their academic achievements on a regular basis and provide progress reports as required
- Create and keep records on attendance, accidents, incidents, and other noteworthy events in accordance with licensing guidelines and program policies
- Attend conferences and workshops in order to further advance professional development
- Manage student behavior in accordance guidelines
- Provide a safe, thriving, and respectful environment for all students in the classroom and on the school.
Education
BA - Computer & Business Management
Herman Lehman College
01-1998
AAS - Computer Management
Bronx Community College
01-1992
Skills
- Computer literate (internet, Microsoft Office; Adobe)
- Type 45 wpm
- Adobe
- Bilingual-English/Spanish
- Customer service
- Strong verbal communication
- Organized
- Data entry
Skills
Bilingual-Fluent in English and Spanish
Timeline
Claims Support Coordinator/Interpreter
Synergy Comp Insurance Co
04.2018 - 05.2026
Synergy Comp Insurance Company
11.2012 - 04.2018
Six Grade Teacher
Immaculate Conception School
01.2000 - 01.2009
AAS - Computer Management
Bronx Community College
BA - Computer & Business Management
Herman Lehman College