Fernando Rex Licea, Ppia Email and Phone Number

 Liaise with all relevant department and clients to ascertain current compliance levels. Create policy and procedure for Safety Department  Evaluate all line coverages to determine wasteful or unnecessary coverages Create and maintaining Driver’s Handbooks, Disaster Recovery Plan, etc Assist Chief Financial Officer with Insurance audits and TPAs invoicing and credits Create all forms for use by various departments. i.e. Inspection, evaluation, accident, etc. … Show more  Liaise with all relevant department and clients to ascertain current compliance levels. Create policy and procedure for Safety Department  Evaluate all line coverages to determine wasteful or unnecessary coverages Create and maintaining Driver’s Handbooks, Disaster Recovery Plan, etc Assist Chief Financial Officer with Insurance audits and TPAs invoicing and credits Create all forms for use by various departments. i.e. Inspection, evaluation, accident, etc.  Audit TPA reimbursement of 10K Deductible and Loss of Use  Right damage estimates to subrogate adverse parties for damages, Ded. and LOU Monitor all ESIS and NARS activities BI settlement Negotiations and authorize settlement  Conduct monthly audits in all required areas to ascertain compliance levels Coordinate Total Loss inspections with COPART and NARS appraisers Issue checks from assigned bank account for: BI/PD/COMP and inland marine damages.  Provide training and education for staff in Florida, Georgia, and North Carolina Evaluate police reports, video footage and other media to further understand the incident Maintain SOS Bulk Claims dbase and Monitor activity on NARS Claims Cube Attend defense attorney interviews, deposition and medication or trial as needed Show less

 Meet with claims quality review teams from BULK, ESIS, NARS, Lockton and Marsh via biweekly, Monthly and Ad hoc meetings to ensure reviews are conducted accurately, timely and consistently  Report meeting recommendations directly to the Legal Executive Committee.  Verify that both Claims adjuster and Defense attorney are following due process, and that claims do not stall. Responsible for authorizing or denying Insurance Carrier requests for reserve increase and Defense… Show more  Meet with claims quality review teams from BULK, ESIS, NARS, Lockton and Marsh via biweekly, Monthly and Ad hoc meetings to ensure reviews are conducted accurately, timely and consistently  Report meeting recommendations directly to the Legal Executive Committee.  Verify that both Claims adjuster and Defense attorney are following due process, and that claims do not stall. Responsible for authorizing or denying Insurance Carrier requests for reserve increase and Defense Attorney requests in all facets of litigation, i. e. Motions, Surveillance, Depositions, Expert Witness, Accident Reconstructions, etc., in the best interest for the Corp. Primary point of contact for all TPAs Attorneys and carrier Show less

 Assist Chief Financial Officer with Insurance audits and TPAs invoicing and credits Create all forms for use by various departments. i.e. Inspection, evaluation, accident, etc.  Review FMCSA and dispute findings via DataQs to lower company exposure Audit TPA reimbursement of 10K Deductible and Loss of Use  Right damage estimates to subrogate adverse parties for Damages, Ded. and LOU Coordinate Total Loss inspections with COPART and NARS appraisers Issue checks… Show more  Assist Chief Financial Officer with Insurance audits and TPAs invoicing and credits Create all forms for use by various departments. i.e. Inspection, evaluation, accident, etc.  Review FMCSA and dispute findings via DataQs to lower company exposure Audit TPA reimbursement of 10K Deductible and Loss of Use  Right damage estimates to subrogate adverse parties for Damages, Ded. and LOU Coordinate Total Loss inspections with COPART and NARS appraisers Issue checks from assigned bank account for: BI/PD/COMP and inland marine damages.  Provide training and education to Safety Department Staff on accident reporting  Evaluate police reports, video footage and other media to further understand the incident Create and maintain SOS Bulk Claims dbase  Attend defense attorney interviews, deposition and medication or trial as needed Show less

Evaluate Jewelry and other luxury items Source precious and semi-precious rough gems from worldwide dealersCut and Facet precious and semi-precious for saleDesign jewelry then sculp on loss wax before smelting

Underwriting Specialist 3/1/2020 – to 5/13/2021) Customer Retention Specialist (3/1/2020 – 5/13/2021)Customer Service Supervisor / Trainer (1/13/2020 – 3/1/2020)

Medicare for United Health and HumanaLife Insurance for National Life GroupPatient Protection and Affordable Care Act (PPACA)

 Lead Customer Services Advocate for prepaid health clinic members with 85% retention and resolution rate Lead Paralegal: attend all area 10 and Area 11 Medicaid hearings on behave of the company  89.9% Grievance and Appeal resolutions rating  80% Customer service resolution rating including member disputes and hostel members In charge of auditing hospitals, clinics, medical diagnostic centers, HHA and DME for fraud, waste and abuse Chief Investigator for MRC for… Show more  Lead Customer Services Advocate for prepaid health clinic members with 85% retention and resolution rate Lead Paralegal: attend all area 10 and Area 11 Medicaid hearings on behave of the company  89.9% Grievance and Appeal resolutions rating  80% Customer service resolution rating including member disputes and hostel members In charge of auditing hospitals, clinics, medical diagnostic centers, HHA and DME for fraud, waste and abuse Chief Investigator for MRC for Medicaid recipients and medical services utilization decisions Show less

 Lead Customer Services Advocate for prepaid health clinic members with 78% retention and resolution rate Lead Paralegal: attend all area 10 and Area 11 Medicaid hearings on behave of the company  65.9% Grievance and Appeal resolutions rating  75% Customer service resolution rating including member disputes and hostel members In charge of auditing hospitals, clinics, medical diagnostic centers, HHA and DME for fraud, waste and abuse Chief Investigator for MRC for… Show more  Lead Customer Services Advocate for prepaid health clinic members with 78% retention and resolution rate Lead Paralegal: attend all area 10 and Area 11 Medicaid hearings on behave of the company  65.9% Grievance and Appeal resolutions rating  75% Customer service resolution rating including member disputes and hostel members In charge of auditing hospitals, clinics, medical diagnostic centers, HHA and DME for fraud, waste and abuse Chief Investigator for MRC for Medicaid recipients and medical services utilization decisions Show less

 Assist Compliance Director in all internal training sessions including HIPAA, Risk, Fraud, and Compliance) Create and update Disaster Recovery Plan and conduct annual committee meeting

 Executive assistant to Corporate Attorney in all legal matters.  Lead settlement negotiator for West Volusia Hospital Authority liability claims at 90% resolution rate  Lead Customer Services Advocate for prepaid health clinic members with 82% retention and resolution rate Lead software group training for Officers and Directors on efficient use of Microsoft Office and other software and peripherals.  Assist Compliance Officer in all internal training sessions… Show more  Executive assistant to Corporate Attorney in all legal matters.  Lead settlement negotiator for West Volusia Hospital Authority liability claims at 90% resolution rate  Lead Customer Services Advocate for prepaid health clinic members with 82% retention and resolution rate Lead software group training for Officers and Directors on efficient use of Microsoft Office and other software and peripherals.  Assist Compliance Officer in all internal training sessions including HIPAA, Risk, Fraud, and Compliance) Create and update Disaster Recovery Plan and conduct annual committee meeting Office Fire Marshall for 8 years responsible for company property and employees during fire emergencies Paralegal in charge of: Trademarks, Corporate filling, Business Tax Receipt, Utilization Review, Third-Party Administrator License and Medicare/Medicaid numbers for 10 domestic entities and 3 foreign entities including Puerto Rico. Show less

 Assisting 20 registered nurses’ needs for information on international clients and new carriers for products and services. Via both group and one on one meetings.  Create promotional packets & advertisement, marketing presentations etc.  Weekly meetings to assign workload and other duties to staff of 10 clerical employees. Meet with international clients and act as liaison between carriers and providers by providing customer services and support to both