Sandra Evans
Levittown,PA
Summary
Experienced claims management leader with over 30 years in customer service and insurance. Known for building strong client relationships and efficiently managing deadlines. Recognized for exceptional communication and problem solving skills, consistently receiving positive feedback from colleagues and clients.
Overview
21
21
years of professional experience
Work History
WC Claims Information Team Lead
New Jersey Manufactures Insurance Company
01.2018 - 01.2025
- Process incoming claim reports from all sources accurately.
- Effectively responded to internal and external customer inquires, delivering accurate information.
- Accurately complete authorization requests.
- Complete callbacks in a timely manner, documenting calls and results in computer correspondence.
- Provided comprehensive training and support to new staff, enhancing team performance.
- resource for Phone Representative's questions regarding process and procedures.
- Provide job shadowing for staff from other departments.
- Managed claim petitions and documentation with precision and attention to detail.
- Monitor incoming claim reports and distribute to staff for entry.
- Review claim entry for accuracy.
- Assign claims for coding review.
- Prepare monthly First Notice of Loss error reports.
- Recode and transfer payments.
- Participate in meetings and testing.
- Maintain documents in department shared drive.
- Monitor department queue.
- Update policy addresses.
- Provide telephone coverage needed.
- Use of Policy center, OnBase, Talispoint, SharePoint.
- Coordinated daily departmental tasks, collaborating with supervisors for optimal workflow.
- Monitor other documents in OnBase and handle them appropriately.
- Support Management projects.
WC Claims-Information Service Department
New Jersey Manufactures Insurance Company
01.2014 - 01.2018
- Lead the processing of incoming claim reports, ensuring accuracy and timeliness.
- Prepare faxed paper reports for department entry
- Route authorization request to appropriate personnel
- Review billing inquiries for medical providers, utilizing On Base, transfer calls and email appropriate personnel.
Customer Service Representative
Diverse Technical Lines Inc
Hatboro, USA
01.2004 - 01.2013
- Greeted customers entering the office and ascertained customers' needs
- Answered an average of 50 calls per day addressing customer inquiries, solving problems and providing new product information
- Processed enrollment applications for Aetna, Independence Blue Cross and United Concordia
- Described insurance policies in detail and cost
- Politely assisted customers in person and via telephone
- Answered product questions with up-to-date knowledge of product
- Investigated and resolved customer inquiries and complaints in a timely and empathetic manner
- Ensured superior customer experience by addressing customer concerns and addressing problems
- Assisted numerous existing and prospective clients each week to evaluate appropriate insurance policies
- Collected all premiums on or before effective date of coverage
- Tracked the progress of all outstanding insurance claims
- Contacted customers regarding delinquent account
Education
Property And Casualty Allied Lines
Pennsylvania Licensed Insurance Agent:
Nursing
Bucks County Community
Newtown, PAMedical Terminology, Interpreting Medical Reports
New Jersey Manufacturers Training
Skills
- Claims processing
- Team leadership
- Customer Service Excellence
- Deadline Management
- Problem Solving
- Highly Dependable
Timeline
WC Claims Information Team Lead
New Jersey Manufactures Insurance Company
01.2018 - 01.2025
WC Claims-Information Service Department
New Jersey Manufactures Insurance Company
01.2014 - 01.2018
Customer Service Representative
Diverse Technical Lines Inc
01.2004 - 01.2013
Property And Casualty Allied Lines
Pennsylvania Licensed Insurance Agent:
Nursing
Bucks County Community
Medical Terminology, Interpreting Medical Reports
New Jersey Manufacturers Training