Alfred Joseph
San Antonio
Summary
Results-driven leader seeking a Claims Facilitator position to serve Our Mission by enhancing the performance of employees through facilitation of learning solutions. Experienced claims professional with more than 12 years of progressive claims experience, including the handling of third-party bodily injury claims of moderate complexity, as well as auto claims involving both injury and non-injury exposures. Demonstrated expertise in conducting thorough liability investigations, evaluating coverage eligibility, and making sound claim decisions while balancing member advocacy with effective risk management.
Currently licensed to handle claims in all West Coast states and Texas. Earned the Certified Insurance Claims Adjuster (CICA) certification, reflecting a strong commitment to continuous learning, professional excellence, and values-driven service aligned with USAA's mission.
Skilled in leading teams, managing high-volume caseloads, and mentoring peers to improve performance, collaboration, and operational effectiveness. Recognized as a strong communicator with exceptional analytical, organizational, and problem-solving abilities, consistently delivering high-quality results in fast-paced, high-pressure environments. Adaptable to changing business needs, flexible with work assignments and scheduling, and willing to travel and work outside of core business hours when required.
Overview
1
1
Certification
24
24
years of professional experience
Work History
ACE Third Part Bodily Injury Adjuster
USAA
San Antonio, TX
06.2026 - Current
- Conducted investigations, evaluations, negotiations, and resolutions of third-party bodily injury claims, ensuring exceptional member service and safeguarding USAA's financial interests. I manage a diverse inventory of complex injury claims by analyzing liability, reviewing medical documentation, assessing damages, and applying policy coverage and state regulations to achieve fair and timely claim resolutions.
- Utilized USAA's core behaviors to achieve high-quality claim outcomes, minimize unnecessary litigation exposure, enhance operational performance, and support USAA's mission of ensuring financial security for its members while delivering exceptional service.
- Evaluated bodily injury claims to determine liability and settlement amounts.
3rd Party Bodily Injury Adjuster
USAA
San Antonio, TX
09.2025 - 06.2026
- I investigate, evaluate, and negotiate third-party bodily injury claims in alignment with USAA’s standards of service, integrity, and fairness. I review medical records, obtain recorded statements, and assess liability. My role also consists of determining appropriate settlements while ensuring compliance with state regulations and company policies. Communicated empathetically with members, claimants, and legal representatives to resolve claims efficiently and equitably, enhancing overall claims experience. I am a CICA certified (Certified Injury Claims Adjuster) recognized for strong analytical judgment, effective negotiation, and commitment to member satisfaction.
- Evaluated and processed bodily injury claims to ensure compliance with company policies and legal regulations.
- Collaborated with medical professionals to obtain necessary documentation for claim assessments.
- Negotiated settlement amounts with claimants, balancing customer satisfaction and company interests.
Disability Claim Analyst III
Principal Financial Group
San Antonio, TX
05.2024 - 05.2025
- Reviewed, analyzed, and adjudicated life and disability claims in compliance with policy terms and legal regulations.
- Maintained detailed records of interactions with approved parties to ensure compliance and facilitate claim management.
- Conducted initial outreach to insureds via letter, email, and phone, and maintained follow-up communication until policy was fully resolved.
- Maintained compliance with HIPAA regulations to protect sensitive patient information.
- Requested and reviewed medical from providers in order to Review claim for benefit eligibility.
- Requested financials such as Medical bills, tax information, UBO4's, and additional provider invoices to verify income eligibility.
- Contacted insureds by letter, email, and phone to conduct initial contact with insured or representative, and follow up as needed until policy was paid in full, continued eligibility or insured is deceased.
- Coordinate with internal and external stakeholders including medical, legal, and underwriting teams.
- Maintained accurate records of all interactions with approved parties
- Requested and reviewed medical from providers in order to Review claim for benefit eligibility.
- Mentor and support peers, offering technical guidance and feedback.
Special Handling Claims Specialist
Continental General LTC Inc
Austin, TX
10.2023 - 05.2024
- Managed incoming claims from initiation to resolution, addressing cases with increasing complexity.
- Manage incoming claims from start to finish, handling cases with increasing levels of complexity.
- Processed escalated long-term care claims involving attorneys, appeals, and complex inquiries, ensuring accurate resolution of overpayments and underpayments.
- Handle and process medical invoices from various healthcare entities, including Medicare and Medicaid.
- Handled medical invoices from healthcare entities, including Medicare and Medicaid, ensuring compliance and timely processing.
- Perform all administrative duties accurately and efficiently within the scope of authority.
Claims Examiner II
Continental LTC Inc
Austin, TX
07.2017 - 10.2023
- Communicated effectively with insureds, authorized representatives, healthcare providers, and internal teams to ensure timely and accurate claims processing.
- Managed incoming long-term care claims from start to finish, performing all administrative duties efficiently and within the scope of authority.
- Managed long-term care claims from initiation to resolution, ensuring thorough administrative support within authority limits.
- Reviewed policy terms to determine coverage eligibility, adhering to HIPAA guidelines and state-mandated timelines.
- Processed medical provider invoices from diverse healthcare entities, including Medicare and Medicaid, to ensure accurate reimbursements.
- Maintained a monthly per-claim authority limit of $15,000 for claim approvals and timely payments.
Auto Claims Adjuster
State Farm
Austin, TX
04.2014 - 07.2017
- Licensed to process and adjust auto claims across nine states, ensuring compliance with varying regulations.
- Received incoming calls and conducted initial interviews with first- and third-party claimants following auto incidents.
- Thoroughly documented every interaction and update related to each claim to ensure complete and accurate records.
- Requested and reviewed medical records, accumulated medical bills, police reports, and other supporting documents necessary for claims resolution.
- Managed administrative duties, including submission of initial, closing, and appeal letters to facilitate claims processing.
- Collaborated closely with agents and clients to prevent processing errors and detect potential fraud.
- Handled all administrative duties, including submitting initial letters, closing letters, appeal letters, and other required communications.
- Collaborated with agents and clients to minimize processing errors and identify potential fraud.
Leasing Agent / Assistant Manager
BG Staffing & Greystar Property Management
Austin, TX
12.2012 - 04.2014
- Managed property operations encompassing leasing, inspections, rent collection, and renewals to ensure seamless daily functionality.
- Performed move-in/move-out assessments, ensured market readiness, and upheld lease compliance standards.
- Leveraged Yardi and OneSite for effective management of resident information and operational processes.
Salesman & Finance Manager Trainee
Leif Johnson Ford / AutoNation Champion Chevrolet
Austin, TX
07.2010 - 12.2012
- Guided customers through vehicle purchases and financing options, enhancing customer satisfaction.
- Processed auto loan applications and structured deals while managing financial documentation to ensure compliance.
- Facilitated DMV paperwork processing to streamline vehicle transactions.
Professional Baseball Player
Chicago Cubs
Chicago, IL
06.2004 - 09.2007
- Drafted in 15th round of 2004 MLB draft as outfielder, signifying recognition of skills and potential.
- Traveled extensively to participate in competitions and training events. and maintained peak performance and discipline in a professional athletic setting.
- Led team in developing strategic game plans to enhance performance during competitive seasons.
- Mentored junior players, fostering skill development and team cohesion on and off the field.
- Analyzed opponent strategies, adapting gameplay to exploit weaknesses effectively.
Outside Manager
Funtrackers Entertainment
Corpus Christi, TX
04.2002 - 06.2004
- Oversaw team operations in recreational environment, maintaining staff accountability and enhancing guest safety.
- Directed daily operations to enhance guest experiences and optimize resource allocation.
- Implemented training programs for staff, improving service efficiency and team performance.
- Analyzed guest feedback to drive strategic improvements in entertainment offerings.
Education
Studies in Psychology (Some College) -
Texas State University
San Marcos, TX12-2009
Associate of Science - Business Management Technology Degree
Ohio University Online
AthensHigh School Diploma - undefined
Foy H. Moody High School
Corpus Christi, TX05-2004
Skills
- Claims analysis
- Customer service communication
- Critical thinking
- Administrative operations
- Claims Management
- Insurance Policy Analysis
- Data Entry
- Microsoft Office Systems
- Time management
- Claims Team Coordination
- Claims Training
- Team leadership
- Training development
- Claims Oversight
- Leadership
- Communication skills
- Claims analysis
- Liability assessment/investigation
- Claims investigation
Certification
- (CICA) Certified Injury Claims Adjuster
Languages
English
Timeline
ACE Third Part Bodily Injury Adjuster
USAA
06.2026 - Current
3rd Party Bodily Injury Adjuster
USAA
09.2025 - 06.2026
Disability Claim Analyst III
Principal Financial Group
05.2024 - 05.2025
Special Handling Claims Specialist
Continental General LTC Inc
10.2023 - 05.2024
Claims Examiner II
Continental LTC Inc
07.2017 - 10.2023
Auto Claims Adjuster
State Farm
04.2014 - 07.2017
Leasing Agent / Assistant Manager
BG Staffing & Greystar Property Management
12.2012 - 04.2014
Salesman & Finance Manager Trainee
Leif Johnson Ford / AutoNation Champion Chevrolet
07.2010 - 12.2012
Professional Baseball Player
Chicago Cubs
06.2004 - 09.2007
Outside Manager
Funtrackers Entertainment
04.2002 - 06.2004
High School Diploma - undefined
Foy H. Moody High School
Studies in Psychology (Some College) -
Texas State University
Associate of Science - Business Management Technology Degree
Ohio University Online