Bilingual Auto Liability Claims Specialist BI

OBJECTIVE

To obtain a position that will enable me to use my strong organizational skills, educational background, experience in the field and ability to work well with people.

To secure a position with a well-established organization with a steady environment that will lead to a long-lasting relationship in the field.

PROFESSIONAL SUMMARY

Professional Bilingual-Spanish Auto Insurance and general liability claims handler able to maintain customer satisfaction while working within company policies and jurisdictional state laws. Adapt easily at utilizing a computer database, handling several ongoing cases simultaneously and reviewing claim files throughout its resolution. I specialize in offering fast and efficient solutions to the variety of cases that are presented to claim adjusters in a daily manner where good judgement and decision making are require at most.

EXPERIENCE

June 2019 – October 2024 – Gallagher Bassett Services, Duluth, GA

Resolution Manager II

Proficiently investigates and handles commercial auto accidents form the beginning of the claim to the end of the claim life.

Manages all aspects of the investigative activity on general liability premisses commercial incidents at home owners and building damages.

Establishes reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.

Develops subrogation demands and negotiate with other and third party insurance companies until settlement is achived.

Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.

Evaluates and settle bodily injury demands in a promptly and equitably manner issueing company drafts in payments for claims within authority limits.

Reviews and research third party property damage estimates to comply with market value standards in the area.

Handles policy interpretation, coverage issues, statutes and state regulations, conducting and guiding investigations, adjustments, file documentation, case negotiation and settlement and strategies.

February 2017 – March 2019 – State Farm Insurance Regional Office, Richardson, TX

Auto – Complex - Injury Claim Specialist

Effectively investigates evaluates, negotiates, and settles Auto claims in assigned injury claims.

Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation.

Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action. Responds to various written and telephone inquiries including status reports.

Reviews coverage, legal liability, extend of damages to injured parties and property which may require contact by telephone, correspondence, or various electronic media.

Ensures adequacy of reserves. Recommends reserve increases on cases in excess of authority.

Review Medical Bills and Medical records to complete Bodily injury evaluations to settle claims within fairs range of value.

Negotiate with claimants or attorney to settle on the value of the case.

Reviews and settles diminish value claims and evidence presented by third party claims.

Applies knowledge of policies, procedures, laws, statutes, and insurance regulations when determining coverage, liability, damages of injury (first and third party) and property damage.

Works in partnership with and provides instruction to claim associates.

May 2016 – February 2017 - State Farm Insurance Regional Office, Ravinia Center Atlanta, GA

Total Loss Claim Specialist

Applies claims settlement procedures to process claims.

Completes Cross Title branding decisions when loss occurred in different state.

Initiate claim payment process and close files assigned by Auto Claim Management, and or electronic assignments.

Assist with the collaboration of internal partners and interface with external vendors, securing releases, and other duties on property claims.

Resolves a large volume of claims in an in-office environment through investigation, evaluation, negotiation, verification of coverage and extent of damage to property

Applies knowledge of policies, procedures, laws, statutes and insurance regulations when determining coverage, liability, and property damage and Title branding.

Works in partnership with and provides instruction to claim associates for claim resolution and settlement negotiations.

September 2013 – May 2016 State Farm Insurance Regional Office, Perimeter center Atlanta GA

Auto Express Claim Adjuster

Excellent customer service feedback, from internal and external customers and the recognition from upper management from Corporate Office.

Permanently being trained for changes in policies and state regulations applicable to claims handling.

I have tutored and trained claim associates that have joined the claims department to the above handling states.

Investigating coverage, managing repairs/rental, and verifying damages against facts of loss.

Considering and managing third party property damage and loss of use.

Work with customers to provide inspection and different repair options.

Responsible for analyzing and determining level of loss for each case and deciding on compensation for clients.

Assisted in gathering data information to follow claim process and establish liability as a result.

Responsible for paying and reviewing estimates and photos to determine level of accuracy for property damage claims.

As the leader of Remarkable Team, I had contributed to my pears with a series of presentations for excellent customer service. As a result, my team has shown an increase high performance in the quality of claim handling.

June 2008 – November 2011 Primerica Life Insurance Co. Duluth, Ga

Special Registration Review Support Analyst

Mentored new members of the special registration review staff.

Research backgrounds for potential recruits with any issue related to criminal, financial, or company owners who could represent a conflict of interest with Primerica Life Insurance Co.

Investigated any potential issues or frauds, focusing on policies and companies’ guidelines.

Obtained through extensive investigation relevant evidence and information regarding suspicious applicants.

Completed required investigations on referred files in a timely manner.

Presenting cases before senior executive committee for resolution and approval.

Responsible for approving and denying application base in financial or criminal records.

Acted as Interim supervisor as designates for 2 months until my manager was returned from maternity leave

February 2003 – June 2008 Primerica Life Insurance Co. Duluth, Ga

Customer Service Representative

Resolved customer inquiries related to billing explanations and account maintenance.

Managed customers’ expectations by clarifying needs and identifying options.

Received service star awards for providing extraordinary customer service.

Implemented training courses for new recruits

Trained all temporary and permanent personnel, including new managers.

Handled 200+ calls per day including research for different departments and follow up for effective customer response.

Completing daily, weekly and monthly report of call center departments.

Assisted Management during absence.

2002-2003 Macys Duluth, Ga

Retail Sales Associate

Assist customers with returns, purchasing store

Answer telephone inquiries from customers and stores regarding inventory.

Assist with new employee training including store policies, services, financing options and register operations.

EDUCATION

2016-2019 Strayer University Atlanta, Ga

Bachelor in Science

Business Administration - Human Resources

1997-2000 Antonio Nariño University Bogota, Colombia

Bachelor

Accounting.

2010-2013 Gwinnett Technical College Lawrenceville, Ga

Associate of Applied Science, Business Management

Operations Management Concentration

2012-2013 Gwinnet Technical College Lawrenceville, Ga

Diploma

Business Management

2011-2012 Gwinnett Technical College Lawrenceville, Ga

Certificate

Human Resource Management Specialist

2010-2011 Gwinnett Technical College Lawrenceville, Ga

Certificate

Management and Leadership Specialist

SKILLS AND ABILITIES

• Excellent writing and verbal communication skills in Spanish and English.

Ability to work well both independently and in a team environment

• Ability to handle multiple and competing priorities

• Proficiency in Microsoft Word

• Experienced in Microsoft Excel and PowerPoint

• Strong knowledge of regulatory and jurisdictional requirements.

• Excellent research and organizational skills

MEMBERSHIP

Phi Theta Kappa Honor Society

Alpha Sigma Lambda Honor Society

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