Xactimate
Angelic Lopez
4811 Fern Lk San Antonio,TX
Summary
Friendly insurance professional with experience in investigating and settling low to complex insurance claims. Knowledgeable and dedicated customer service professional. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with all customers/vendors. Motivated to maintain customer satisfaction and contribute to company success. Achieved a CSR III position within 2 years of employment at Nationwide due to exceptional engagement, member experience and efficiency results. After 8 years accepted a position as a Claims Specialist I within the Property organization and achieved a Claims Specialist II position in 2023 due to exceptional results in customer satisfaction and organization's metrics.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Claims Specialist II
Nationwide Insurance Company
11.2021 - Current
- Handled property claims from low complexity to high complexity.
- Opens, closes and adjusts reserves according to company practices to ensure reserve adequacy. Adheres to file conferencing notification and authority procedures.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Partners with Special Investigation Unit and Subrogation to identify fraud and subrogation opportunities. Assists or prepares files for lawsuit, trial or subrogation.
- Streamlined the claims process for clients with proactive case management, regular updates, and prompt resolution.
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Achieved performance targets consistently through attention to detail, effective time management, and strong decision-making abilities.
Customer Service Analyst II
Nationwide Insurance
09.2014 - 11.2021
- Creates loss reports by securing data from members, claimants, agents, or other parties.
- Verifies coverage under various policies or policy provisions based on variance line of state, jurisdiction, and regulatory requirement.
- Knowledgeable in handling all personal lines and commercial lines for first notice of loss
- Member of the Advisory council, providing feedback on how to improve communication and making a positive contribution to the company.
- Expert in many computerized system for information gathering.
- Member of the schedule automation change.
- Created special workflows for Nationwide's affiliates and working with one of our trainers.
- Achieved Mid year CSR for having the highest quality results in the BU.
- Assisting peers weekly doing by side by sides.
- Works with internal partners to build and improve our partnership by having scheduled meetings that contribute to our success
- Maximizes efficiency expectations on meeting the BU numbers for talk time, AHT, after call work, and adherence
- OYS Mentor- helping peers and leaders seek out solutions to trends while managing my time well and positively contributing to business unit service levels.
- Embraces root cause problem solving developing a mindset that includes the voice of the customer, voice of the business unit, and voice of the associate
- Focuses on internal procedures by creating action plans to support areas that maintain a positive energy on trends impacted.
- Provided success to the implementation of the new Fraud form
- Completed a coaching methodology course that advanced coaching techniques
Customer Service Representative II
Nationwide Insurance
07.2014 - 09.2014
- Achieved Outstanding rating for CSR II
- Provided first line customer services contact for claims reporting activity in a fast paced environment
- Creates loss reports by securing data from members, claimants, agents, or other parties.
- Makes direct assignments for internal and external customers.
- Verifies coverage under various policies or policy provisions based on variance line of state, jurisdiction, and regulatory requirement.
- Knowledgeable in handling all personal lines calls.
Customer Service Representative I
Nationwide Insurance
05.2013 - 07.2014
- Provided first line customer services contact for claims reporting activity in a fast paced environment
- Creates loss reports by securing data from members, claimants, agents, or other parties.
- Makes direct assignments for internal and external customers.
- Verifies coverage under various policies or policy provisions based on variance line of state, jurisdiction, and regulatory requirement.
- Knowledgeable in handling all personal lines calls.
Medical Biller
Bexar Care Home Medical Equipment
10.2009 - 03.2013
- Verified insurance and obtained patient benefits.
- Initiated and completed authorizations/referrals.
- Data entry and patient demographics and insurance data.
- Worked on aged accounts; unpaid claims, outstanding patient balances.
- Initiated and completed claim appeals.
- Responsible for obtaining detailed physician orders, supporting medical records, title XIX's and certificates of medical necessity.
- Posted insurance and patient receipts.
- Prepared claims for submission.
- Electronic claims submission.
Education
Associate of Applied Science -
North East Lakeview College
San Antonio, TX4 2021
Skills
- Xactimate Certification Level I
- Writing estimates
- Claims Investigation
- Claims Analysis
- Fraud Detection
- Insurance Knowledge
- Decision Making
- Estimate Preparation
- SME (subject matter expert)
- New Hire Mentor
- Team player
- Detailed-oriented
- Advisory Council Member
- Conflict Resolution
- Data entry
- Coaching team members
Certification
- Claims Adjuster Cerfitied Professional
- Texas Property and Casualty Insurance, All lines of business adjuster license
- Continuing Education: Ethical Principals Certification, Ethical Business Practices: Diversity, Equity, and Inclusion Certification
Software
XACT analysis
Timeline
Claims Specialist II
Nationwide Insurance Company
11.2021 - Current
Customer Service Analyst II
Nationwide Insurance
09.2014 - 11.2021
Customer Service Representative II
Nationwide Insurance
07.2014 - 09.2014
Customer Service Representative I
Nationwide Insurance
05.2013 - 07.2014
Medical Biller
Bexar Care Home Medical Equipment
10.2009 - 03.2013
Associate of Applied Science -
North East Lakeview College
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