James M. Aliosius
22547 Mission Dr.
Richton Park, IL. 60471
Bus. (630) 369-5396 x5249
Eve. (708) 747-4181
Summary: Extensive experience in the insurance and software industries as a Claim Analyst for
several insurance companies and as an Analyst for an insurance related software
company. Proficient in claim adjudication process, including departmental
workflow design, as well as software analysis and business requirement consulting.
Excellent written and oral communication skills.
Washington National Insurance Co. Lincolnshire, IL. 8/95 to 11/97
Claim Analyst Promptly adjudicated all claims in assigned region (including
California) under company Hospital Indemnity Plan, Medical Reimbursement
plan, Non-Disabling Injury Plan and
Sick Leave Plan. Successfully processed
all Short/Long term disability claims with special emphasis on company exposure.
Performance of underwriting functions required in instances of requests for greater
coverage levels.
Medicon, Northbrook, IL. 9/94 to 8/95
Senior Claim Adjuster Successfully evaluated all medical claims received from
providers. Compiled and submitted weekly payment reports to Finance Department
for release of funds as well as monthly payment reports concerning specialty claims.
Resolved problems to ensure proper payment of claims and provider satisfaction.
AON Corporation, Chicago, IL. 5/85 to 9/94
Senior Technical Specialist (11/93 - 9/94) In addition to duties of Senior Claim
Adjuster, was given responsibility of adjudicating all "high risk" Long Term disability and Life claims as well as Short Term disability claims which had involved
lengthy investigation. Worked closely with in-house Attorneys as well as those
representing claimants, successfully negotiating and settling claims in litigation.
Replied to all regional Insurance Department complaints received.
Senior Claim Adjuster (5/88 - 11/93) Successfully completed the California Claim Practices Examination; was appointed to handle the Long Term Disability claims from California. Assisted in the hiring and performed the training of new adjusters. Assisted experienced Adjusters with more complex disability claims. Approved all decisions and correspondence in cases of denial of benefits and rescission of coverage. Performed quality reviews of Adjusters on a monthly basis. Assisted in the development of a referral system which reduced the chance of error in the application of policy provisions relating to benefits paid and the denial of benefits.
Claim Adjuster (5/85 - 5/88) Completed an extensive medical training program. Corresponded heavily with lienholding institutions, Attorneys, Physicians and Claimants. Promptly resolved disputed claims through negotiation with Attorneys and lienholders, satisfying all parties involved, and avoiding potential litigation. Took the initiative to reduce the number of delinquent accounts by contacting Claimants their Physicians and Employers thereby obtaining information necessary for prompt resolution of conflicts.