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Elena Lumbreras
Sr Claim Supervisor @CCMSI
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WORK HISTORY
Sr Claim Supervisor @CCMSI
Review, assign and provide supervision of all claim activity for designated claims to ensure compliance with Corporate Claim Standards, client specific handling instructions and in accordance with applicable laws.• Investigate, evaluate and adjust assigned claims in accordance with established claim handling standards and laws.• Reserve establishment and/or oversight of reserves for designated claims within established reserve authority levels.• Provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims• Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.• Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.• Assist designated claim staff in the selection, referral and supervision of designated claim files sent to outside vendors.(i.e. legal, surveillance, case management, etc.)• Provide education, training and assist in the development of claim staff.• Review and maintain personal diary on claim system.• Supervision of all claim activity for specified accounts.• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.• Performs other duties as assigned.• Provide over site for our in house telephonic nurse and IME vendor.• Provide month reports to the Client on over site of Nurse Case Management and our IME vendor.• Run reports as needed for clients and manager.
EDUCATION
Northern Illinois University
B.A
SKILLS
ABOUT ELENA LUMBRERAS
Sr. Claim Supervisor at CCMSI
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