BERENICE GAONADUARTE
Claims Adjuster
Cicero,IL
Summary
Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes. Results-oriented Claims Adjuster bringing hands-on law enforcement experience and exceptional leadership and communication skills. Background includes criminal investigation, insurance fraud and surveillance.
Overview
12
12
years of professional experience
Work History
Sales Associate
Nike
10.2024 - Current
- Help customer with items and advised of sale promotions.
- Help customers order online orders through our system.
- Ring customers and process refunds.
- Assist on the floor, cleaning after every shift. Support other co workers.
- Process truck and shipment when received.
Claims Adjuster
PNC
01.2024 - Current
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Determined liability outlined in coverage and assessed documentation such to understand damages incurred.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Identified potential fraud indicators early in the investigation process, protecting company assets from potential losses due to fraudulent activity.
- Researched claims and incident information to deliver solutions and resolve problems.
Claims Adjuster
Kemper Insurance
08.2021 - 12.2023
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
Claims Adjuster
Falcon Insurance
Oak brook, IL
05.2018 - 07.2021
- Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.
- Post or attach information to claim le.
- Contact insured or other involved persons to obtain missing information.
- Provided status on claims Pay out invoices for Estimates Open new claims.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Reported to management on customer problems, field conditions, safety issues and policy problems.
- Substantiated legitimate claims and denied unjustified claims.
- Answered customer questions regarding deductibles.
AGENT
Oxford Insurance
Cicero, IL
01.2016 - 05.2018
- Sell various types of insurance policies to businesses and individuals on behalf of insurance companies, including automobile, re, life, property, medical and dental insurance or specialized policies such as marine, farm/crop, and medical malpractice.
- Interview prospective clients to obtain data about their nancial resources and needs, the physical condition of the person or property to be insured, and to discuss any existing coverage.
- Call on policyholders to deliver and explain policy, to analyze insurance program and suggest additions or changes, or to change bene ciaries.
- Ensure that policy requirements are ful lled, including any necessary medical examinations and the completion of appropriate forms.
- Customize insurance programs to suit individual customers, often covering a variety of risks.
- Calculate premiums and establish payment method.
- Perform administrative tasks, such as maintaining records and handling policy renewals.
- Confer with clients to obtain and provide information when claims are made on a policy.
AGENT
First Acceptance Insurance
Cicero, IL
10.2013 - 01.2016
- Sell various types of insurance policies to businesses and individuals on behalf of insurance companies, including automobile, re, life, property, medical and dental insurance or specialized policies such as marine, farm/crop, and medical malpractice.
- Interview prospective clients to obtain data about their nancial resources and needs, the physical condition of the person or property to be insured, and to discuss any existing coverage.
- Call on policyholders to deliver and explain policy, to analyze insurance program and suggest additions or changes, or to change bene ciaries.
- Seek out new clients and develop clientele by networking to nd new customers and generate lists of prospective clients.
- Ensure that policy requirements are ful lled, including any necessary medical examinations and the completion of appropriate forms.
- Calculate premiums and establish payment method.
- Select company that.
- Ers type of coverage requested by client to underwrite policy.
- Contact underwriter and submit forms to obtain binder coverage.
- Confer with clients to obtain and provide information when claims are made on a policy.
Education
M.B.A - Business Administration Management of Technology
MORTON COLLEGE
High School Diploma - undefined
J. STERLING MORTON
Skills
- Customer service
- Insurance
- Policies
- Speaking
- Spanish
- Automobile claims specialist
- Personal, casualty and property loss
- Insurance Policy Coverage Knowledge
- Illinois, Texas and Oklahoma Claims Adjuster License
- Policy renewals
- Quotes and sales
- Property insurance
- Claims reporting systems
Additional Information
- LICENSES AND CERTIFICATIONS , Illinois Licensed Agent Texas Licensed Adjuster
Certification
- Licensed Texas licising - 1yr
Accomplishments
- Maintained a consistent closing ratio of 80%.
- Conflict Resolution - Responsible for handling customer account inquiries, accurately providing information to ensure resolution of service complaints and customer satisfaction.
- Desk withing compliance within company requirements.
- Documented and resolved coverage claims which led to insurance company not paying coverage claims.
Quote
"So long as life remains, there is always hope... and so long as there is hope, there can be victory!"
Languages
Spanish
Native or Bilingual
Timeline
Sales Associate
Nike
10.2024 - Current
Claims Adjuster
PNC
01.2024 - Current
Claims Adjuster
Kemper Insurance
08.2021 - 12.2023
Claims Adjuster
Falcon Insurance
05.2018 - 07.2021
AGENT
Oxford Insurance
01.2016 - 05.2018
AGENT
First Acceptance Insurance
10.2013 - 01.2016
M.B.A - Business Administration Management of Technology
MORTON COLLEGE
High School Diploma - undefined
J. STERLING MORTON
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