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Maria
Claims and Customer Service Specialist with 10+ years in finance and insurance
Contacto
Competencias
Handled all aspects of claims processing, from data gathering to case assessment, at Sedgwick and SSA.
Provided ongoing support and communication to insured parties and claimants to facilitate smooth claims resolution.
Interviewed claimants, medical specialists, and employers, and collected evidence to support claims validation.
Verified funds, processed payments, and balanced cash drawers at Western Credit Union, maintaining strong controls.
Utilized Spanish language skills to assist a diverse client base in claims and customer service contexts.
Educación
Idiomas
Resumen
Experienced professional with comprehensive skills in claims processing, customer relations, and financial transactions across insurance, government, and banking sectors.
Logros Clave
- Mentored 5 new claims staff at Social Security Administration, enhancing team capabilities.
- Developed connections with local fraud bureaus and legal agencies to improve case investigations.
- Consistently delivered quality customer service throughout claims lifecycle, ensuring timeliness and accuracy.
Experiencia
Leave of Absence Coordinator
During the Intake process, gathered detailed information and completed various Leave of Absence requests., Consulted with field support team, including team lead and adjusters to receive support specific to assigned claim., Delivered quality customer service to assigned, insured and claimants throughout entire claims lifecycle to promote effective service times for all parties., Provided quality customer service to all assigned, insured and employees throughout claims process to deliver timely service to customers., Identified and collected evidence and determined value to specific claim to properly assess conditions., Reviewed data to verify validity of claims and determine case management actions., Interviewed claimants, medical specialists, and employers to determine pertinent claim information.
Debt Collector
Remained calm, stayed professional and provided exceptional service on all calls, even when interacting with difficult individuals., Reviewed accounts to determine payment plan compliance., Fielded incoming phone calls from customers and directed to corresponding department or individual for assistance., Processed payments over phone and set up recurring drafts., Secured payments by following up with customers which disregarded promise to pay., Routinely contacted account holders with balances over 90 days past due to resolve delinquencies., Accepted and processed customer payments and applied toward account balances.
Claims Representative - Retirement/Disability Claims
Mentored 5 new members of claims staff in proper procedures., Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims., Promoted agency products to customers in person, by telephone and in writing., Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions., Researched coverage and premium options and supplied clients with best coverage available for individual needs., Attended anti-fraud training courses, conferences, client SIU training and industry seminars., Conducted interviews, gathered detailed information, and completed field investigations., Worked with underwriting on loss reserves and risk assessment and coordinated field reviews., Consulted with field support team, including claim manager, quality control, file review, team lead and adjusters to receive support specific to assigned claim., Delivered quality customer service to assigned, insured and claimants throughout entire claims lifecycle to promote effective service times for all parties., Provided quality customer service to all assigned, insured and claimants throughout claims process to deliver timely service to customers., Developed connections with local fraud bureaus, district attorneys' offices and professional associations., Identified and collected evidence and determined value to specific claim to properly assess conditions., Reviewed data to verify validity of claims and determine case management actions., Communicated with insured individuals to explain audit classifications and computations., Interviewed claimants, medical specialists, and employers to determine pertinent claim information., Managed and maintained all filed hazard and special hazard claim documentation.
Lead Bank Teller
Verified amounts and integrity of every check or funds transfer., Helped customers open and close accounts, apply for loans, and make sound financial decisions., Conducted special service and account transactions for customers, including ordering checks and placing stop payment orders., Maintained optimal financial controls by securing funds and making accurate transactions., Performed currency transaction reports for foreign currency., Warmly welcomed customers and offered pleasant service during entire transaction., Offered to take on additional shifts during holidays and other busy periods to alleviate staffing shortages., Performed basic administrative tasks regarding banking products, including handling phone calls, inquiries, and emails., Greeted and assisted over 30 customers per day professionally and courteously., Kept teller window areas clean, organized and fully stocked., Handled cash transactions, balanced cash drawers, performed loan payments and issued cashier's checks., Increased knowledge of banking products and services by actively participating in available training classes and workshops offered to employees.