Customer Service Claims Adjuster
Resume:
Lesli Barrientos-Gutierrez
Houston, TX 77016
******************@*****.***
OBJECTIVE:
I would like to obtain an available position in the claims department for your company. I plan to utilize my extensive experience in claims handling, leadership, and customer service to perform my job duties. I plan to be a great asset to the company when given the opportunity.
CAREER PROFILE:
*I am bilingual (English & Spanish), Detail-oriented, efficient and organized professional with
* I have extensive experience working remotely in claim handling, leadership, and customer service.
* I possess strong analytical, investigation and problem solving skills to downgrade difficult situations.
* I withhold the ability to make well thought out decisions and expose excellent written and verbal communication skills in both English and Spanish.
* I am a trustworthy and hard-working person with great multi-tasking skills and attention to detail.
* I am very resourceful and proactive in the completion of claim handling, investigations and projects with deadlines.
EXPERIENCE:
Allstate Insurance, September 2021- Present
Catastrophe Claims Adjuster
•Under guidance, partners closely with field adjustors and/or independent adjustors to investigate and determine appropriate coverage for Property claims while providing exceptional customer service throughout the life cycle of the claim.
•Determines policy coverage, sets reserves, and determines whether claim will be approved or denied, including recommendations made by independent and/or field adjustors.
•Clearly explains coverage to customer and notifies insured of coverage or any issues.
•Handled supplements and refers others as appropriate.
•Works with and may coordinate a number of vendor services, according to the appropriate coverage, such as contractors, experts, emergency repair, cleaning services and various replacement services while ensuring the customer is appropriately communicated to.
•Maintains accurate and current claim file documentation throughout the life cycle of claim cases.
•Recommends referral to SIU where appropriate and may assist the SIU in their investigation and settling of the claim
•Made recommendations to management for settlement amounts outside of authority limits. Closes claim files upon completion of final payment.
•Participates in suit committees, roundtables, arbitrations and mediations.
•Completed training and courses to become an Area Coaching Expert status. Participates in continuous improvement activities as assigned Qualifications
•Required working knowledge of claims handling procedures and operations.
•Understands and can write structural damage estimates of channeled Property losses of low complexity.
•Proven ability to provide exceptional customer service.
•Negotiation skills.
•Ability to effectively manage workload while exhibiting good judgment.
•Strong written/oral communication and interpersonal skills.
•Computer skills with the ability to work with multi-faceted systems and analytical skills.
Granada Corporation, January 2013- June 2021
Claims Adjuster/Investigator
Evaluate and investigate policy coverage, liability and damages in a timely manner following a set of general claim and statutory guidelines
Assist internal and external customers with problems or questions regarding claims by phone or through written correspondence while providing a high level of customer service.
Establish initial reserves for all potential exposures and adjust as appropriate throughout the claim
Investigate and evaluate claims using a lowest ultimate cost strategy.
Establish and maintain appropriate management of assigned inventory following company guidelines.
Conduct thorough investigations including obtaining necessary documents and forms from claimants and insureds; conducting recorded statements.
Ensure timely completion of appraisals and determine accident related damages.
Communicate with involved parties and negotiate appropriate settlements with claimants, insureds and in some cases body shops and attorneys within approved payment authority
Establish and maintain appropriate management of assigned inventory following company guidelines
Review and process mail relating to assigned claims
Recognize recovery opportunities relating to subrogation and salvage
Recognize suspicious claim characteristics and the indicators of fraud and refer such claims to the Special Investigations Unit for review
Granada Corporation, February 2011- December 2013
Customer Service Representative
Responded promptly and answered/resolved customer inquiries and complaints.
Investigated and resolved service issues and/or product problems
Managed customers’ database accounts, performed customer verification and processed applications, orders and requests.
Worked with administration: forwarded requests and unresolved issues to the designated resource by communicating and coordinating with internal departments.
Kept records of customer interactions and actions taken, including – transactions, comments, inquiries and complaints.
Supplied customers with written responses and information and followed up on customer communications.
Manage large amounts of inbound and outbound calls in a timely manner.
Follow communication “scripts” when handling different topics.
Identify customers' needs, clarify information, research every issue and provide solutions and/or alternatives.
Interact with customers in response to inquiries, concerns, and requests about products and services
Gather customer/product information and determine the issue by analyzing the symptoms
Particípate in frequent 1:1/classroom video coaching sessions with leadership
Become a trained insurance professional and help customers service their insurance policies through exciting life events.
Ensure customers have the right level of coverage while identifying and resolving customer conflicts
EDUCATION:
South Texas College of Law Houston- TX, Juris Doctorate Degree, August 2022 (Currently Attending)
University of Texas at Arlington- TX, Masters Degree, May 2022.
University of Houston Downtown- TX, Bachelors Degree, December 2019.
Houston Community College, TX- Asociaste Degree, December 2016.
High School Graduate from Sam Houston High School, Houston, TX- 2013.
SKILLS:
Microsoft Word, Excel, PowerPoint, Outlook Express, Microsoft Windows XP and Microsoft, Avaya, Five9, Microsoft Teams, Zoom, Go To Training.
Office XP Professional. 10-Key, Fax, 10 lines Phone System, QuickBooks Desktop.
Type: 50WPM, Xactimate
Contact this candidate