Results-oriented insurance professional bringing hands-on investigative experience, exceptional leadership, and communication skills coupled with a high level of integrity. Background includes numerous years of multi-faceted insurance claim handling, supervision, and fraud investigations.
Overview
43
43
years of professional experience
1
1
Certification
Work History
Claim Specialist
State Farm Mutual Automobile Insurance Company
06.2024 - Current
Reviewed and maintained accurate claim files, ensuring all necessary documentation was in place for future reference.
Maintained compliance with industry regulations by staying up-to-date on changes in policies and procedures, ensuring proper handling of sensitive information.
Conducted thorough investigations into insurance claims to determine coverage eligibility and appropriate compensation amounts.
Enhanced customer satisfaction with prompt and accurate claim resolutions, resulting in positive feedback and increased client retention.
Provided exceptional customer service during difficult situations, displaying empathy while explaining complex claim issues clearly to clients.
Collaborated closely with adjusters to ensure accurate, fair, and timely claims settlements for all involved parties.
Evaluated and settled complex insurance claims in strict timeframes.
Fostered team-oriented environment that emphasized continuous improvement in claim handling procedures.
Identified fraudulent activity through meticulous analysis of claim data, protecting company resources from potential losses.
Senior SIU Investigator
VRC Investigations
06.2019 - 03.2024
Investigate multiple insurance lines of business on behalf of several insurance companies for claim decision purposes, and to determine whether there are indicators of fraud that warrant further investigation.
Collect clear requirements from clients and update each regularly on case progression and to obtain additional objectives.
Conduct phone or in-person recorded statements with insureds, claimants, and witnesses.
Conduct scene investigations.
Obtain investigative photographs and videos.
Complete detailed and accurate investigative reports.
Conduct investigations for QBE Insurance Company utilizing their Guidewire portal for direct access to their claim files.
Supervise case files involving SIU Field Investigators.
Licensed Private Investigator
Claim Specialist
State Farm Insurance Companies
09.2021 - 02.2022
Investigated vehicle damage inflicted resulting from emergency situations and natural disasters.
Conducted complex claim investigations in order to move the claims to a proper resolution.
Coordinated with local repair facilities on vehicle repairs and obtained rental vehicles for customers for duration of restoration process within the policy limits.
Prepared a variety of different written communications, reports and documents to ensure smooth operations.
Evaluated practicality of repair as opposed to payment of market value of vehicle before loss.
Examined photographs and any other documents relating to claims.
Determined salvage value on total-loss vehicles.
Issued payouts to insureds.
Carried and managed consistently heavy workload through exemplary organizational, time management and collaboration talents.
Conducted database searches.
Utilized CCC to obtain vehicle valuations.
Identified suspicious claims, escalating issues to SIU for further investigation and analysis.
Claim Specialist
State Farm Insurance Companies
09.2017 - 12.2017
Investigated vehicle damage inflicted resulting from emergency situations and natural disasters.
Coordinated with local repair facilities on vehicle repairs and obtained rental vehicles for customers for duration of restoration process within the policy limits.
Prepared a variety of different written communications, reports and documents to ensure smooth operations.
Evaluated practicality of repair as opposed to payment of market value of vehicle before loss.
Examined photographs and any other documents relating to claims.
Determined salvage value on total-loss vehicles.
Issued payouts to insureds.
Carried and managed consistently heavy workload through exemplary organizational, time management and collaboration talents.
Conducted database searches
Utilized Autosource to obtain vehicle valuations.
Identified suspicious claims, escalating issues to SIU for further investigation and analysis.
Claim Specialist-SIU
State Farm Insurance Companies
07.1998 - 02.2016
Investigated claims involving potential and suspected fraudulent activities.
Documented all investigation activity and presented reports to management.
Conducted extensive field investigations.
Substantiated and settled legitimate claims and denied unjustified claims.
Collaborated with the industry anti-fraud organizations, such as the National Insurance Crime Bureau (NICB), to resolve claims.
Conducted extensive database searches.
Partnered with legal counsel on litigation cases.
Testified on behalf of State Farm as part of criminal and civil proceedings.
Established productive working relationships with public officials and law enforcement officers.
Provided training to line unit claim specialists as well as claim specialists in the Special Investigative Unit.
Conducted extensive project investigations in the Organized Activities Unit.
Claim Supervisor
State Farm Insurance Companies
05.1988 - 07.1998
Trained, coached and mentored team in the area of claim handling, estimatics, and customer service.
Hired personnel when appropriate.
Reviewed claim files and provided direction to claim specialists in order to move files to a proper resolution.
Reviewed vehicle damage estimates and provided appropriate feedback to estimators when applicable.
Provided guidance and direction to support personnel.
Conducted garage and glass shop surveys in the area.
Prepared detailed reports for upper management.
Responsible for the overall claim operation along with co-managers in the service centers.
Worked directly with other departments within the organization.
Responsible for the salary administration of team members.
Actively engaged with outside defense counsel hired to handle files in litigation.
Successfully implemented innovative programs and enhancements as directed by upper management.
Company wide reorganization eliminated this position.
Claim Specialist
State Farm Insurance Companies
08.1981 - 05.1988
Evaluated insurance policies and analyzed damages to determine coverage.
Drafted investigative reports covering all phases of the investigation in each case.
Properly evaluated and resolved assigned bodily injury and property damage claims.
Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
Conducted field recorded interviews and scene investigations.
Provided direction to outside defense counsel on litigation files as deemed appropriate.
Assisted in the training of new team members.
Education
Bachelor of Science - Criminal Justice
Pan American University/UT-RGV
Brownsville, Texas
12.1979
Associate of Applied Science - Law Enforcement Technology
Texas Southmost College
Brownsville, Texas
05.1978
Skills
Highly motivated and dedicated
Advanced oral and written communication skills
Organized
Customer service-oriented
Insurance policy coverage expertise
Property & Casualty loss handling
Skilled investigator
Leadership background
Advanced computer skills
Litigation
Texas All Lines Adjuster License
Licensed Private Investigator
Accomplishments
Chartered Property Casualty Underwriter (CPCU)
Associate in Claims (AIC)
Languages
Spanish
Full Professional
Certification
ICAR
Affiliations
Outstanding Young Men of America- 1984
Graduate of Leadership Brownsville-1997
Timeline
Claim Specialist
State Farm Mutual Automobile Insurance Company
06.2024 - Current
Claim Specialist
State Farm Insurance Companies
09.2021 - 02.2022
Senior SIU Investigator
VRC Investigations
06.2019 - 03.2024
Claim Specialist
State Farm Insurance Companies
09.2017 - 12.2017
Claim Specialist-SIU
State Farm Insurance Companies
07.1998 - 02.2016
Claim Supervisor
State Farm Insurance Companies
05.1988 - 07.1998
Claim Specialist
State Farm Insurance Companies
08.1981 - 05.1988
ICAR
Bachelor of Science - Criminal Justice
Pan American University/UT-RGV
Associate of Applied Science - Law Enforcement Technology
Texas Southmost College
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