Customer Service Claims Adjuster

CECILIA M. CORTEZ

H: 210-***-**** *********@*****.***

CAREER SUMMARY

Leadership-oriented with management experience and exceptional people skills in the insurance industry. Versed in problem solving, research and analytical reports. Recognized as a strong coach and trainer who is able to develop direct/indirect reporting relationships. Experienced Senior Claims Examiner with excellent client and project management skills. Action-oriented with strong ability to communicate effectively with technology, executives, and investigation in order to meet deadlines. Self-motivated and dependable while achieving high performance with minimal supervision. Experienced Caregiver in direct care for geriatric and impaired patients to optimize overall health and well-being. EXPERIENCE

10/11/2021 - 03/24/2025

Auto Bodily Injury Claims Specialist

Total Loss Claim Specialist

State Farm Insurance - Richardson, TX

● Strong skills in verbal and written communication with positive customer service.

● Knowledge of legal, medical terminology, negotiation, analytical and fraud.

● Reviewed and determined course of action on each auto/bodily injury claim assigned.

● Conducted thorough investigations and kept accurate and relevant documentation of file activity on each claim which included coverage liability status and complete property loss damages. Determined claim value, facilitated fair settlements to ensure compliance with relevant laws and regulations.

● Work closely with Third parties plaintiff attorneys to determine necessary injury and coverage investigation.

● Prepared and presented claim evaluations for the appropriate settlement authority in order to bring the file to a conclusion.

01/25/2021 - 09/30/2021

Claims Medical Examiner

Cognizant Technology - Lewisville, TX

● Superior medical claims processing knowledge of research, resolution of Adjustment inquiries and/or correspondences.

● Analyze patient and medical information queries to identify instances where investigation for determining appropriate Claim Benefits, Pricing, Prior Authorization or Coordination of Benefits is necessary and process claims accordingly.

● Review and release voids, adjustments, and high dollar claims directed by Team Leader.

● Researched pended claims to ensure timely adjudication within accepted corporate cycle times.

● Identify based on review and research of pending reports, and inform management of opportunities for quality improvement and best practices of claims operations through re-training or system modifications.

03/2019 – 11/2020

Represented Casualty Specialist

Allstate Insurance – San Antonio, TX

● Perform investigative duties which includes medical billing for attorney timed demands. ● Handle represented casualty claim files by locating/request and reconstructing missing files for adjusters.

● Process claim payments.

● Experience with Mitchell, ISO, CARPE DATA, NextGen, AdjusterWorkspace and Arbitration Forums.

● Inquiry calls for Total Loss, Liability, Bodily Injury utilizing excellent customer service.

● TDY Assignment – India – Subrogation TSR Review Arb Decisions – Skilled in critical thinking for Subro awards in casualty loss. Reviewed outcome for benefit/loss of each claim. Top production performer on a weekly basis. Completed 2,314 tasks in a four (4) month period. 09/2012 to 03/2019

Caregiver - Geriatric/Impaired

Self Employed San Antonio, TX

● Assisted disabled individuals to foster independence while still closely monitoring safety.

● Worked to improve patient outlook and daily living through compassionate care.

● Monitored clients' progress to report necessary changes to family. 05/2012 to 09/2012

Life Enrichment Instructor

The Arc of San Antonio San Antonio, TX

Summer job

Ensured learning opportunities geared toward achievement of individual training objectives for adults with mental/physical disabilities by providing quality rehabilitation and vocational services. 05/2011 to 03/2012

House Manager

Enhanced Living Services San Antonio, TX

● Cultivated a pleasant and safe setting by using organization and knowledge, which was widely embraced by residents, employees and those who visited.

● Researched and planned fun activities that would be enjoyable for both residents and guests, including a Spurs basketball game.

● Oversee five employees, led recruiting and hiring, managed employee review process and ensured compliance with state and federal regulations. 09/1999 to 11/2009

Lead Underwriter / Claims Processor

Nationwide Insurance San Antonio, TX

● Provided agents and customer service with expertise in risk assessments and underwriting policies.

● Utilized advanced understanding of underwriting criteria to provide approvals or rejections for applications.

● Presented and clearly explained insurance policy options to clients based on their needs and goals.

● Processed applications, payments, corrections, endorsements and cancellations. ● Responded to customer questions through telephone, email and online chats.

● Advised to determine loss of moderately complex auto claims via conference calls. ● Guided the new hires with knowledge, excellent quality, and proficient production. EDUCATION AND TRAINING

2018 San Antonio College - All Lines Insurance Adjuster License for Texas 2011 Wayland Baptist University - Bachelor of Science Occupational Education

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