Kimberly Paulo Email & Phone Number

Philippines

US Workers’ Compensation Insurance- Process projection of client companies’ Workers’ Compensation experience modification factor (ex-mod factor) over the next policy year using Zywave.- Identify drivers of increase or decrease in ex-mod factor for 120 client companies and report these findings to account managers.- Compare actual vs forecasted ex-mod factor and troubleshoot variance.- Monitor WCIRB and NCCI published ex-mod factor and notify clients’ account managers. - Maintain a document of historical ex-mod factors of all the client companies.- Process loss analysis report by creating comprehensive loss summary using provided data; Tabulate and graph data on loss runs (past claims) to aid account managers visualize highlights, determine insurance program’s scope, and accurately recommend and place coverage. - Process loss pick for client companies to assist account managers determine necessary financial reserves and estimate total ultimate loss costs derived from analyzing five years of historical data.- Process loss-sensitive program analysis to aid account managers with risk management insights used to help client companies to reduce costs and promote safety and loss control.- Process collateral review for client companies to aid account managers with client’s current collateral policy structure.- Process loss stratification for client companies to aid account managers visualize degrees of loss severity to evaluate the multi-faceted characteristics of Workers’ Compensation claims more efficiently.US Healthcare Insurance- Process Non-discrimination Testing (NDT) for client companies to aid account managers evaluate the fairness of client’s benefits and ensure that these benefits are accessible to all eligible employees and in compliance with Internal Revenue Service (IRS) guidelines.

Philippines

US Workers’ Compensation Insurance- Process projection of client companies’ Workers’ Compensation experience modification factor (ex-mod factor) over the next policy year using Zywave.- Identify drivers of increase or decrease in ex-mod factor for 120 client companies and report these findings to account managers.- Compare actual vs forecasted ex-mod factor and troubleshoot variance.- Process analytical reports such as loss analysis, loss projection, loss-sensitive program analysis, collateral review, and loss stratification.US Healthcare Insurance and Stop Loss Insurance- Process claims report, calculate actuarial value, prepare request for proposals, complete book of business, process benchmarking report and process underwriting report.Administrative Tasks- Plan, document, and maintain Workers’ Compensation task procedures to ensure business continuity and compliance with ISO.- Participate during company’s ISO audit to ensure team’s compliance.- Create report templates to ensure accuracy in ex-mod factor calculation and variance analysis.- Collaborate with automation team to improve the process time, by 60%, of loss analysis report using Macro tool. - Present loss analysis reports to potential client producers and pitch workers’ compensation team’s report capabilities.- Maintain internal documents such as but not limited to client communication, client contacts and minutes of the meeting.- Assist supervisor in reviewing and analyzing team’s monthly utilization report.- Daily monitor team’s capacity and deliverables. Allocate daily task per team members.- Conduct new employee trainings to ensure effective knowledge transition. - Conduct inter-departmental audits to ensure report accuracy.- Assist junior teammates with their deliverables during peak season.- Assist in processing new task request from account managers.

Philippines

US Healthcare and Life Insurance and Stop Loss Insurance- Process Non-discrimination Testing (NDT) for client companies to aid account managers evaluate the fairness of client’s benefits and ensure that these benefits are accessible to all eligible employees and in compliance with Internal Revenue Service (IRS) guidelines.- Process monthly Claims Report for client companies to aid account managers with tables and graphs to visualize the summary of incurred claims per month and per plan. - Calculate the Actuarial Value of the health plans to be used in reports using Summary of Benefits and Coverage file to aid clients identify how competitive the plans are.- Prepare Request for Proposal (RfP) report for client companies to aid account manager summarize current rates, contributions, insurance carrier history, and commission for each plan.- Complete Book of Business showing the enrollment, premium and revenues of each client companies per insurance carrier using the data from different files (Sold Transition, Audit and Summary of Benefits and Coverage).- Process Benchmarking report to compare current benefits, rates, and demographic profile of the client company with the norm in Mercer National Survey and provide overall assessment on the significant difference.- Process underwriting reports to aid account managers with client’s census demographic summary, quotes for competitive insurance premiums, detailed records of policies underwritten and decisions made.- Encode client companies’ revenue in the system based on benefit details and build database for benchmarking.- Assist client companies in requesting Stop-loss proposals from five partner insurance carriers. Tabulate the proposals to aid account managers compare, recommend and place coverage.Ad Hoc Tasks- Assist enrollment process by ensuring the beneficiaries are added in the system and the employee submitted the correct required documentation.