Josie Menor
Markham
Summary
Your summary will appear here
Overview
39
39
years of professional experience
1
1
Certification
Work History
AB Claim Advisor
Allstate Insurance
09.2018 - Current
- Interpret insurance policy wording, determine policy coverages, and set reserves
- Investigate, negotiate, and settle accident benefit claims of moderate to high complexity by telephone, in person and/ or by written correspondence;
- Comply with best practices as set out in Company policies and procedures;
- Adhere to legislative and regulatory requirements;
- Ensure files are thoroughly documented;
- Settlement of claims within personal authority and follow company guidelines on claims exceeding personal authority;
- Set and define customer service expectations;
- Take ownership and accountability to solve customer problems;
- Maintain a caseload reflective of an AB Claim Advisor, Accident Benefits;
- Communicate and interact with claimants, vendor, medical professionals, lawyers in a professional manner;
- Work collaboratively with a team of Accident Benefit Adjusters and Claims Assistants;
- Other tasks assigned by Manager.
Case Facilitator
One Health Team
05.2016 - 09.2018
- Working in a high-volume and fast paced environment.
- Review member insurance claims for entitlement according to specific insurance policy in place.
- Advise parties of their entitlement verbally and in writing in a timely manner.
- Communicate complex and sensitive processes in a means that members can interpret and find useful.
- Establish strong rapports with patients creating complete patient information files and coordinating insurance payment information with each patient file.
Case Manager
WSIB
11.1986 - 10.2015
- Develop, implement and monitor comprehensive and integrated case management plans.
- Provide targeted activities focused on identifying RTW factors, removing obstacles, and leveraging opportunities to facilitate a safe return to work.
- Communicate with clients, lawyers, health care practitioners and other stakeholders to obtain information, provide status and provide written and verbal decisions.
- Identify influencing factors medical and non-medical, restrictions and limitations to support what is required for a safe return to work.
- Actively coordinate and facilitate RTW cooperation between workplace parties.
- Inform parties of their rights and obligations under the Workplace Safety and Insurance Act, and consequences of non-compliance.
- Attempt to prevent or resolve disputes, handle requests for reconsideration and if appealed arrange access and process the objection.
- Refer requests for health care entitlement to Nurse Consultant and liaise when determined to be required.
- Determine worker's entitlement to benefits, rehabilitative/support devices, services and supports.
- Fully conversant with WSIB policies, policies and legislation to ensure appropriate eligibility, lost time monitoring, recovery, early RTW initiates, application of cost relief and appeals procedure.
Skills
- TIME MANAGEMENT - 10 years
- Case Management
- Spanish
- ORGANIZATIONAL SKILLS - 10 years
Certification
Your certifications and licences will appear here
Languages
Fluent in Spanish with ability to speak, read and write in native proficiency.
Spanish
Native or Bilingual
Additional information
- Excellent time management and organizational skills, with the ability to set priorities and utilize time effectively when managing multiple tasks.
- Familiar and experienced with working well under pressure, able to assess complex information and make timely decisions with a sense of urgency.
- Excellent communication and listening skills and experience handling disputes in a clear and sensitive manner.
Timeline
AB Claim Advisor
Allstate Insurance
09.2018 - Current
Case Facilitator
One Health Team
05.2016 - 09.2018
Case Manager
WSIB
11.1986 - 10.2015