Jacqueline Perez
St. Cloud,FL
Summary
Motivated Team Lead possessing excellent leadership and planning abilities. Focused on delivering high-quality products on tight schedules. Monitors, trains, and encourages employees to improve skills and meet demanding targets. History of successfully developing and managing strong teams through proactive training and issue management.
Overview
23
23
years of professional experience
Work History
Senior Claims Examiner
Lincoln Financial Group
11.2024 - Current
- Reduced claim resolution time by conducting thorough investigations and timely decisionmaking.
- Enhanced customer satisfaction through prompt communication and comprehensive claim explanations.
- Established trust among clients by consistently delivering fair assessments of their insurance claims.
- Mentored new hires during their onboarding process, sharing insights from years of experience as a Senior Claims Examiner.
- Developed and maintained relationships with key stakeholders, fostering a cooperative working environment.
- Handled high-profile cases professionally, maintaining confidentiality while achieving satisfactory resolutions.
- Reviewed policy coverage details meticulously, ensuring accurate determination of benefits payable in each case.
- Coordinated with medical professionals to obtain necessary documentation for evaluating injury claims accurately.
- Contributed to company growth by consistently meeting or exceeding productivity targets without sacrificing quality standards.
- Researched claims and incident information to deliver solutions and resolve problems.
- Examined photographs and statements.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
Workforce Management Team Lead
Sedgwick
06.2018 - 10.2024
- Modifies and directs project plans to meet organizational needs
- Orchestrates projects within strict timeframes and budget constraints by solving complex problems and working closely with senior leaders
- Achieves project deadlines by coordinating with operations to manage performance
- Develops executive presentations and reports to facilitate project evaluation and process improvement
- Supervises multiple teams of examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit
- Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office
- Provides technical/jurisdictional direction to examiner reports on claims adjudication
- Compiles, reviews and analyzes management reports and takes appropriate action
- Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards for claims focused on ADA, FMLA and other federal, state and local standards
- Assists, promotes, and coordinates staff engagement activities, programs, and events
- Acts as second level of appeal for client and claimant issues regarding claim specific, procedural, or special requests; implements final disposition of the appeal
- Reviews reserve amounts on high-cost claims and claims over the authority of the individual examiner
- Operate business and office machines such as copiers, scanners, and other equipment
- Assures that direct reports are properly licensed in the jurisdictions serviced
- Ensures claims files are coded correctly and adequate documentation is made by claims examiners.
Service Center Team Lead
06.2016 - 06.2018
- Supervise team of 15-23 Service center representatives’ along with assisting in overseeing other teams when team lead is absence
- Assesses and evaluates current team competencies to develop a baseline of service opportunities
- Leads efforts to refine Service Center measures and tracking systems for program improvements
- Maintains records of training activities, colleague progress and program effectiveness
- Analyzes and resolves customer service issues
- Supervises a Service Center unit (team) providing leadership, direction and support and monitors team's daily performance
- Monitors workloads and status; supports colleagues by providing advice on handling complex issues; and identifies and resolves problems and issues
- Works with team leadership to develop, implement and monitor staff development plans with a focus on overall customer service skills
- Communicates with upper management regarding unit issues and resolutions.
Senior Service Center Representative
09.2015 - 06.2016
- Handle entering of new Short term disability and Leave of absence requests based on FMLA guidelines for Walmart callers, while following client specific instruction using claims management systems
- Assesses and evaluates current team competencies to develop a baseline of service opportunities
- Leads efforts to refine Service Center measures and tracking systems for program improvements
- Maintains records of training activities, colleague progress and program effectiveness
- Analyzes and resolves customer service issues
- Supervises a Service Center unit (team) providing leadership, direction and support and monitors team's daily performance
- Monitors workloads and status; supports colleagues by providing advice on handling complex issues; and identifies and resolves problems and issues
- Works with team leadership to develop, implement and monitor staff development plans with a focus on overall customer service skills
- Communicates with upper management regarding unit issues and resolutions.
Education
Bachelors - Business Management
AIU Online
Hoffman Estates, IL07.2017
Skills
- Active Listening
- Critical Thinking
- Problem Solving with focus in customer service
- Oral and Written Communication
- Interpersonal Skills
- Leadership
- Time Management
- Computer Literate
- Research Expertise
- Trend tracking
- Regulatory Compliance
- Production Monitoring
- Schedule Management
- Performance monitoring
- Talent Acquisition
- Human Resources Management
- Employee engagement
- Diversity and Inclusion
- Coaching and Mentoring
- Key Performance Indicators
- Performance Improvement
References
References
Available upon request.
Education and Training
true
Languages
Spanish
Native or Bilingual
Timeline
Senior Claims Examiner
Lincoln Financial Group
11.2024 - Current
Workforce Management Team Lead
Sedgwick
06.2018 - 10.2024
Service Center Team Lead
06.2016 - 06.2018
Senior Service Center Representative
09.2015 - 06.2016
Bachelors - Business Management
AIU Online
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