Rose M. De Los Santos
McAllen,Texas
Summary
Results-driven Risk Manager bringing proven skills in administering claims management, commercial insurance, health & safety, and risk management programs. Effective in training team members to proactively identify and highlight potential risks. Dedicated to long-term risk management by building strong internal protocols and instilling a culture of responsibility and attentiveness.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Risk Manager - Workers' Compensation Mgr
SWBC-PEO
01.2023 - 02.2024
- Provided professional support to the CEO and Chief Operating Officer.
- Supervised a team of claims specialists to ensure timely reporting of claims and ongoing claim management.
- Maximized performance by monitoring daily activities and mentoring team members.
- Conducted thorough analysis of historical data, helping identify patterns and trends in potential risks.
- Ensured stakeholders were registered and insured in appropriate states including Mexico, and Canada.
- Handled all administrative tasks for insurance annual renewals such as broker renewals, Certificate of Insurance, Third Party Administrator, and monopolistic states compliance, including all lines of coverage were properly in place.
- Investigated workplace accidents and incidents to minimize loss, reduce future risk, and protect the safety equipment and personnel.
- Worked closely with the executive team to provide loss runs data, analytical reports, and communicate any potential hazards.
- Investigated on-site catastrophic claims, reported any OSHA reportable, and provided OSHA 300 and 301 reports to stakeholders, as necessary.
- Ensured consistent compliance with state and federal regulatory requirements and remained abreast of emerging state and federal regulatory legislation to all lines of insurance coverage.
- Served as the primary point of contact for all internal and external stakeholders in Risk Management matters
- Provided all Certificate of Insurance for stakeholders to include oversight of annual renewals.
- Worked closely with the Third-Party Administrator to ensure the effective handling of claims.
- Negotiated settlement claims within designated authority.
- Inspected work site facilities and equipment to determine any potential accidents or hazards and recommend corrective actions then follow-up to ensure corrective action has been in place.
- Conducted adequate training for the management team while conducting onsite visits.
- Ensured all State and Federal posters were distributed and updated for the Workers’ Compensation Program to include TPA’s information.
- Investigated difficult claims by investigating and gathering information to determine the exposure of the claim and corrective action.
- Investigated fraudulent claims including running ISO searches, social media activity, assigning private investigators, running background searches, and mandating drug screens promptly.
- Fostered a working relationship with in-network urgent care clinics, and account representatives.
- Appropriated reserves to the claim and through the life of the claim.
- Assisted with financial analysis for the department.
- Participated in quarterly claim reviews.
- Directed communication with injured employees, attorneys assigned to litigated claims, and potential witnesses to obtain necessary information to investigate accidents or the continuation of claim management.
- Managed the litigation process of the claim to ensure timely and cost-effective claims resolution.
- Coordinated private investigator assignments and assigned attorneys on litigated claims.
- Reported current and legacy claims to the excess carriers.
- Executed Workers’ Compensation payroll reporting for Monopolistic States and Canadian Providences.
- Coordinated responses to requests for production and interrogatories and attended mediations to ensure proper representation.
- Prepared management and analytical reports on a weekly and monthly basis.
- Responsible for investigating, evaluating, and resolving all claims promptly and professionally.
- Monitored the return-to-work program.
- Conducted Workers’ Compensation, General Liability, and Auto Liability training.
- Conducted regular audits of existing policies and procedures, ensuring their continued effectiveness in addressing organizational goals related to mitigating risks.
- Developed strong relationships with internal stakeholders, promoting a culture of risk awareness and accountability.
- Collaborated with cross-functional teams to establish effective risk management practices across all business units.
- Trained employees on risk management best practices, empowering them to make informed decisions regarding potential risks.
- Evaluated emerging risks in the market through continuous monitoring and research, enabling proactive response measures.
- Streamlined communication channels between various departments, ensuring timely sharing of critical risk information.
- Reduced operational risks by implementing robust risk management strategies and procedures.
- Reviewed contracts for potential liabilities or exposures, recommending adjustments as necessary to minimize overall legal and financial impact on the organization.
- Supported executive decision-making by providing accurate and timely reports on enterprise-wide risk exposure levels.
- Enhanced risk identification processes for early detection and mitigation of potential threats.
- Encouraged stakeholders to approach assessments analytically and offer unique insights to bring new understanding to risk management programs.
- Achieved regulatory compliance by ensuring adherence to industry standards and guidelines related to risk management.
- Identified opportunities for process improvement and cost reduction through insightful analysis of current risk management practices.
- Fostered a culture of continuous improvement in risk management, encouraging feedback from employees to identify areas for enhancement.
- Improved company''s risk profile with comprehensive risk assessments and reporting mechanisms.
- Managed insurance programs efficiently, balancing coverage needs with budgetary constraints while maintaining adequate protection against losses.
- Handled [Type] claims according to internal risk management policies, keeping liability minimized by leveraging expertise and available tools.
- Produced and filed reports to inform senior management of current activities and progress with investigations.
- Completed statistical reviews to uncover trends, patterns and variations.
- Managed and motivated employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
- Maintained professional, organized, and safe environment for employees and patrons.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Cross-trained existing employees to maximize team agility and performance.
- Communicated clearly with employees, suppliers, and stakeholders to keep everyone on the same page and working toward established business goals.
- Developed a strong company culture focused on employee engagement, collaboration, and continuous learning opportunities.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
Risk Management Analyst
ISS Facility Services, Inc.
03.2015 - 10.2022
- Provide professional support to the Risk Management Director
- Managed and oversight of the TPA’s and carriers to ensure effective and efficient handling of General Liability, Workers’ Comp and Auto claims
- Determined coverage, facts of loss and liability/exposure and with defense counsel on litigated claims
- Negotiated settlement claims within designated authority
- Inspected work site facilities and equipment to determine any potential accidents or hazards and recommended corrective actions
- Conducted Workers’ Compensation, General Liability and Auto Training, Claims Reporting Processes, and Service with A Human Touch Training in English and Spanish throughout North America as well as
- Traveled throughout the U.S
- To conduct in-person training
- Managed all Certificate of Insurances for the organization to include renewals
- Processed difficult claims by investigating and gathering information to determine the exposure on the claim
- Determined validity and compensability of the claim
- Appropriated reserves to the claim and through the life of the claim
- Assisted with the departmental budgeting for workers’ compensation
- Participated in quarterly claim reviews
- Directed communication with the claimants, attorneys, witnesses, and health & safety team and/or branch administrations to obtain necessary information to investigate a claim
- Managed the litigation process of the claim to ensure timely and cost-effective claims resolution
- Coordinated private investigators and assigned attorneys to questionable claims
- Reported claims to excess carriers
- Served as support and consultancy to the various corporate departments and branch administration to facilitate process enhancements within the operations to minimize and mitigate risk exposures
- Workers’ Compensation payroll reporting for Monopolistic States and Canadian Providences
- Ensured consistent compliance with state and federal regulatory requirements and remained continuously abreast of emerging state and federal regulatory legislation related to workers comp
- Coordinated responses for requests for production and interrogatories and attended mediations to ensure proper representation
- Prepared management and analytical reports on a weekly and monthly basis
- Responsible for investigating, evaluating, and resolving all claims promptly and professionally
- Monitored the return-to-work program.
- Assisted with minimizing risk exposure by reviewing claim validity and viability against coverage standards.
- Developed short-term goals and long-term strategic plans to improve risk control and mitigation.
- Helped risk management team produce timely reports analyzing [Type] data.
- Verified certificates of insurance for accuracy and conformance with internal risk management policies and coordinated issuance to individuals and entities.
- Produced timely reports on [Type] processes, highlighting control programs' strengths and weaknesses in detail.
- Advised senior managers on policy strategies for reducing liability and preventing losses.
- Taught employees how to control risks at front line.
- Investigated allegations to check validity and recommend actions to minimize risk.
- Instituted regular safety inspections and hazards management strategies to keep operations compliant.
- Encouraged stakeholders to approach assessments analytically and offer unique insights to bring new understanding to risk management programs.
- Employed strong program management skills to successfully define and manage ongoing initiatives designed to control [Type] risks.
- Handled [Type] claims according to internal risk management policies, keeping liability minimized by leveraging expertise and available tools.
- Worked with new providers to place and appropriately cost [Type] plans.
- Maintained current team documentation, validated codes and tracked invoices to keep accounts and records current.
- Managed company-wide complaints and subpoenas alongside legal teams and risk management staff.
- Supported [Number]-member risk management team with multifaceted administrative assistance such as organizing and transmitting records.
- Managed relationships with external auditors and regulators ensuring compliance with relevant standards and requirements.
- Consistently met deadlines for completing critical tasks such as regulatory reports or board presentations related to strategic risks faced by the organization.
- Provided expert advice on complex risk issues, guiding informed decision-making within the company.
- Streamlined reporting processes for efficient communication of key risk indicators to stakeholders.
- Championed a culture of risk awareness by sharing insights and best practices with colleagues, fostering an environment in which every employee took responsibility for managing potential risks effectively.
- Conducted regular reviews of existing risk management practices, recommending improvements as needed.
- Facilitated open communication channels between departments for better identification and assessment of interconnected risks.
- Conducted interviews with key business users to collect information on business processes and user requirements.
- Improved business direction by prioritizing customers and implementing changes based on collected feedback.
Risk Associate
Archdiocese of San Antonio
01.2010 - 03.2015
- Provide professional support to the Risk Director
- Conducted onsite inspections to include any potential accidents, detect existing risks and safety hazards, and provided recommendations to correct and prevent any findings of my inspection
- Provided Certificate of Insurance to contractors
- Received claims, confirmed policy coverage, and acknowledgment of the claim
- Determined validity and compensability
- Assisted in property, general liability, and auto claims including investigating, evaluating, negotiating, and managing the claims in a prompt and professional manner
- Reviewed new Workers’ Comp claims to include tracking lost time, Work Status Reports, answering questions from injured workers and supervisors, and monitoring Drug and Alcohol Testing
- Directed the Light Duty/Return-to-Work Program
- Assisted WC Carrier with requests including wage statements, job duty classification, employee information, and light duty availability
- Evaluated claim reserves and request adjustments; monitored all active and open claims; attended Benefit Review Conferences
- Processed all driver record searches and coordinates correspondences relating to the record search such as approval, denial or suspension notices as well as communicate with the department or agency regarding the drivers’ status to include reinstating driving privileges
- Interpreted and applied Archdiocese rules and regulations; State Laws- Texas Department of Public Safety regulations for all drivers to include
- Reviewed, and processed all incoming requests for Certificate of Insurance promptly
- Ensured that approved drivers for the Archdiocese attended a Defensive Driving Course including maintaining a large database of volunteers and employees to track expired DDC and Driver Records
- Organized necessary training and safety courses for all employees and volunteers
- Provided general office support such as: serving as a point of contact for building maintenance; maintaining and updating the filing system; distributing mail; answering telephones; screening all calls, visitors, mail, and responding to general sensitive requests for information and assistance; ordering office supplies.
Risk Analyst
City of San Antonio
09.2001 - 09.2008
- Assigned to the Office of the Director to provide a variety of complex and professional administrative and risk support
- Processed Driver Evaluations for all COSA Departments
- Monitored the outstanding arrest warrant list from Municipal Courts to include notifying the departments and suspending employees’ driving privileges
- Maintained the COSA training database for city employees to include uniformed personnel
- Scheduled City employees for various training courses using SAP system (i.e., CPR, Defensive Driving, DOT and etc)
- Coordinated the Safety Coordinator’s meeting to include taking meeting minutes, and transcribing the minutes and the city-wide Safety Coordinator’s list
- Processed all suspended, canceled, and revoked driver’s licenses to include notifying the department and suspending driving privileges and reinstating privileges after receiving proper documentation
- Created and implemented handouts and forms used for various safety training courses
- Processed all reports to include inspection reports, hotline complaints, and DOT Supervisors and Drivers reports
- Participated in the monitoring of the department’s budget to include preparing reports for management
- Partnered with Internal Affairs to investigate internal and external complaints and grievances
- Assisted in the coordination of City events including City Employees Appreciation Ceremonies, Award Banquets, Employee Recognition, City Job Fairs, and administering Fire and Police entry and promotional testing
- Researched, maintained, and processed all requests for unemployment benefits through the Texas Workforce Commission
- Processed and maintained databases for all Open Records requests, City Manager’s requests, and HR Projects on a time sensitive basis
- Maintained and reconciled a variety of books, ledgers, and accounts and examines all transactions for accuracy
- Examined standard accounting documents for completeness and conformance with specific accounting requirement
- Prepared and sent mail-outs to all City retirees regarding benefit payments, delinquencies, and termination of benefits
- Ensured that department staff have up-to-date Defensive Driving course training, current Driver Evaluations, and authorization to utilize motor pool.
Education
Business Administration in Management -
University of Incarnate Word
08.2024
Skills
- Staff Management
- Team Leadership
- Claim Reviews
- Claims Handling
- Complex Problem-Solving
- Time Management
- Verbal and written communication
- Ability to handle confidential information
- Excellent investigation skills
- Minimal supervision is required
- Strong computer skills
Certification
- Licensed Property & Casualty Adjuster - 08/08/2014 to Current
- Licensed All-lines Adjuster
- Certified Registered Workers’ Compensation Specialist (RWCS), The National Registry- November, 2022
Languages
Spanish
Full Professional
Timeline
Risk Manager - Workers' Compensation Mgr
SWBC-PEO
01.2023 - 02.2024
Risk Management Analyst
ISS Facility Services, Inc.
03.2015 - 10.2022
Risk Associate
Archdiocese of San Antonio
01.2010 - 03.2015
Risk Analyst
City of San Antonio
09.2001 - 09.2008
Business Administration in Management -
University of Incarnate Word
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