Customer Service Claims Adjuster

Rocio Pomare-Leon

********@*****.*** 770-***-****

Independent Claims Adjuster

Results-oriented and analytical professional with hands-on experience in the insurance claim industry with a proven track record of efficiently examining claims, gathering client information, identifying and resolving claim issues, and approving/denying claims based on findings. Succeeded in serving as a focal point of contact for customers while guaranteeing the delivery of exceptional services, thereby attaining 100% client satisfaction.

Proven ability to handle complex claims efficiently, adhering to industry regulations and client satisfaction. Adept at conducting thorough inspections, collaborating with various policyholders, and negotiating fair settlements. Possesses excellent communication and interpersonal skills, ensuring effective communication with policyholders, claimants, and other parties involved. Proactive problem solver with a commitment to accuracy, compliance, and delivering superior customer service.

CORE COMPETENCIES

Claims Processing

Claim Investigation

Regulatory Compliance

Risk Assessment

Customer Service

Fraud Detection

Coverage Analysis

Claim Documentation

Settlement Negotiation

Notary Public

Proficient in CCC One estimating software

Astute Communication

CAREER EXPERIENCE AND ACHIEVEMENTS

EBERL CLAIMS SERVICE. LLC – Dunwoody, GA

External Claims Task Associate – State Farm Auto Express • 2022 – 2023

Provide guidance to clients navigating the claims process while addressing minor complaints during the claims-handling process. Conducted follow-up calls to gather necessary updates on claims and scheduled appraisals in coordination with relevant parties. Managed incoming mail related to claims, ensured timely and appropriate responses, and organized documents for easy reference.

Reviewed police reports, processed and handled No call Require (NCR), Call Require (CR), Auto Estimation Billing Review (AEBR), and Sent to Subrogation (STS) tasks.

Regularly updated and maintained status notes for every individual claim and kept policyholders informed of claims’ progress.

Eberl Claim Services – Dunwoody, GA

External Claims Resource –State Farm Auto Property Complex – Virtual/Spanish • 2022

Initiated and managed claims process, including thorough investigation of claims to assess validity and determine coverage. Maintained detailed and accurate file notes documenting key actions, decisions, and communications, as well as managed calendars to ensure timely follow-ups and adherence to deadlines. Facilitated the release of payments in accordance with established procedures and guidelines. Utilized State Farm Claims Service platform and navigated complex Quality Field Contacts (QFC) to gather and process information relevant to claims. Provided support in Spanish to Spanish-speaking clients, ensuring effective communication and understanding.

Conducted recorded statements from insureds and claimants, reviewed police reports, monitored default calendars to address time-sensitive tasks and activities and handled initiation of new claims, Auto Estimation Billing Review (AEBR), and processed new mail tasks promptly.

Send To Subrogation (STS) as required, addressing unique or complex situations in the claims process.

Conducted Diminished Value (DV) assessments to evaluate the reduction in monetary value of the vehicle following repairs.

Contributed to engaging with customers to provide updates on claims status, address inquiries, and ensure customer satisfaction.

EA RENFROE – Irving, TX

External Claims Task Associate – State Farm Auto Weather Catastrophe Total Loss • 2022

Ensured completion of quality first contact with claimants, collecting all necessary information to initiate the claims process effectively. Processed and released payments in accordance with established authority limits. Carried out timely follow-up calls to claimants to gather additional information, provide updates, and address any concerns.

Coordinated and set up inspections for weather inspections to assess the extent of damage caused by weather-related events.

Regularly updated detailed status notes for each claim, documenting key actions, decisions, and communications.

Collaborated with internal teams, including adjusters, inspectors, and support staff, to facilitate efficient claims resolution.

EBERLS CLAIMS SERVICE, LLC – Dunwoody, GA

External Claims Task Associate – State Farm Auto Injury Virtual • 2021 – 2022

Assisted clients in navigating claims procedures and effectively resolving minor complaints throughout the claims-handling process. Ensured the processing of claims aligned with both client and corporate policies, procedures, and best practices, maintaining compliance with statutory, regulatory, and ethical requirements. Performed meticulous data entry tasks, including preparing and updating claim files and forms accurately.

Applied sound judgment and decision-making skills to analyze claims exposure, determining appropriate actions for resolution.

Conducted follow-up calls, coordinated appraisals, arranged rentals, and released payments within specified authority limits.

Maintained comprehensive status notes for each individual claim, providing a transparent overview of the claim's progress.

Handled incoming mail and efficiently managed tasks related to No Call Require (NCR), Call Require (CR), Auto Estimation Billing Reviews (AEBR), and Send to Subrogation (STS).

EARLIER WORK EXPERIENCE

EPICITY INC – Atlanta, GA • Security Guard

COCA COLA REFRESHMENTS – Alpharetta, GA • Customer Communications Specialist

CORPORATE TEMPS, COCA COLA REFRESHMENTS – Lilburn, GA Customer Communications Specialist

HK & N TAX SERVICES – Lilburn, GA Office Manager

GWINNETT PLACE NISSAN – Duluth, GA Auto Sales Consultant/Spanish Translator

EDUCATION

General Studies Georgia Perimeter College – Clarkston, GA

Bilingual/Spanish Certification, ACTFL (2022) State Farm Auto/Policy/Fire Estimatics Certified (2021) / Allstate Auto Adjuster Certified (2023)

LANGUAGES

English Spanish

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