Operations / Claims Manager
JaaNook Inc; d/b/a Trustworthy Insurance
Total years of experience :28 years, 7 Months
Managing operations and general insurance claims ensuring insured satisfaction, tracking producers business, advise cross function marketing and sales initiatives.
o Preparation of budget, planning, analysis and setting goals for the sales team.
o Negotiate with insureds / clients and assessing business needs recommending optimal solutions.
o Ensure excellent relationship with both internal and external customers to expand business opportunities.
o Understand changes to insurance policy wordings that impact insureds ensuring continuous improvement and growth.
o Ensure compliance with Texas Department of Insurance rules and regulations for running a successful & ethical insurance agency operations.
o Managing all aspects to ensure successful business growth, achieve targets, cross function marketing and sales initiatives.
o Responsible for budget preparation, planning, analysis and setting goals for the sales team.
o Identify and negotiate with key clients to assess business needs and recommend optimal solutions.
o Maintain excellent relationship with both internal and external customers to expand business opportunities.
o Understand changes to insurance policies, procedures and strategies to ensure continuous improvement and growth.
o Ensure compliance with Texas Department of Insurance rules and regulations for running a successful & ethical organization.
- Interpret, help, and explain health insurance benefits to Medicare and ACA (Affordable Care Act - also known as ObamaCare) members, certified HIPAA Diploma Holder.
- Select health-care providers, research NPI registrations using company resources, expedite renewal documents, correspond with prospects throughout United States, where licensed.
- Create health insurance benefit awareness. Generating leads, and maintain retentions.
o Responsible for advising prospective clients on a wide array of commercial and personal insurance products, including providing risk management services.
o Solicit insurance coverage to commercial and personal lines by customizing their needs and requirements.
o Negotiate appropriate clauses with various underwriters and provide clients with optimal insurance protection for their needs and requirements.
o Promote a wide array of customized insurance products and services including commercial, marine, liability, life, health, home and auto.
o Maintain excellent relationship with regional underwriters and divisional headquarters to expedite coverage and claims.
o Investigate, evaluate and dispose claims within assigned authority for different line of business, including commercial, property, and marine insurance.
o Liaise with underwriters and reinsurers with a view to their understanding / imposition of various insurance clauses, wordings that affect coverage / claim / liability.
o Set and review claims reserves, emphasize performance benefits and risk-improvements.
o Inspect marine cargo shipments at seaport, monitor off-loading operations to ensure safe landing and temporary storage at seaport.
o Record damage / possible claims if any for subrogation purpose, and handling claims.
o Suggest packing improvement measures to minimize losses to importer / insurer.
o Contact claimants, witnesses, physicians, law enforcement authorities and vendors for assessing and settling claims.
o Promptly settle loss within assigned authority, determine liability and resolve coverage issues. Select and assign outside adjusters for losses beyond authority.
o Dispose claims in a timely and ethical manner, following A.M. Best’s Claims Practices and providing best possible customer experience / retention.
Four Years Course Study in : a) Claims Handling Principles and Practices - including activities in the claim process, basic investigation, fraud detection, good-faith claim handling, ethics, negotiation skills, and litigation management. b) Worker's Compensation and Managing Bodily Injury Claims - including Worker's Compensation system, compensability, statutory benefits, bodily injury claim management and treatment evaluation, impairment and disability, rehabilitation, low back injury claims, medical investigation, and assessing treatments of disability. c) Property Loss Adjusting - including Persons/Property insured, causes of loss, loss adjusting process and procedures, fraud detection, residential construction, preparing estimates, merchandise / time element loss, auto physical damage, and contractor's equipment. d) Liability Claims Practices - including Liability investigation, evaluation of damages, litigation management, auto / home . commercial liability and coverage issues, settlement, alternative dispute resolution strategies, and case studies.