DANA POLICE
Pomona,CA
Summary
Accomplished Claims Generalist Associate with a proven track record at Progressive Insurance Company, adept in claims processing. Enhanced customer satisfaction through efficient workflow strategies and critical thinking. Skilled in conflict resolution and policy knowledge, significantly reducing claim processing time while managing over 50 claims weekly.
Overview
5
5
years of professional experience
Work History
Claims Generalist Associate
Progressive Insurance Company
07.2023 - Current
- Managed high-volume caseloads while consistently meeting deadlines and maintaining quality standards for claim resolutions.
- Improved customer satisfaction ratings by providing prompt and accurate responses to inquiries regarding claim status.
- Provided top-notch customer service throughout the claims process, ensuring a positive experience for policyholders and claimants to reinforce Progressive's brand reputation.
- Worked productively in a fast-moving work environment to process large volumes of claims.
- Policy interpretation for coverage analysis.
- Determine coverage and liability for claims resolution.
- Interview insureds, claimants and witnesses to properly determine liability status.
- Ability to manage a heavy case load of claims efficiently while managing the claims process from start to finish.
- Determine liability by gathering statements, photos, police reports and other supporting documents.
- Negotiate with insured, claimants and other insurance carriers to resolve claims.
- Support peers by being available for incoming calls.
- Resolve total loss claims by communicating with insured/claimants and lien holders.
- Ability to build relationships with managed repair representatives, attorneys, insurance carriers and body shops.
- Referring claims for subrogation as needed.
- Ability to recognize potential fraud.
- Understanding the importance of job metrics for efficiency and productivity.
Claims Examiner II
National General Insurance Co/Allstate Insurance
06.2019 - 06.2023
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Review claims data, investigate the loss, determine coverage, liability and finalize within authority.
- Determine subrogation and fraud potentials.
- Manage 50+ claims weekly using appropriate customer service.
- Keeps the insured and others informed about the claim's status with clear, timely and accurate written /oral communications,
- Affirms or denies coverage coverage of the claim based on the facts and the policy terms and conditions.
- Meet time requirements of the policy and fair claims handling practices.
- familiar with California, Oregon and Washington claims and policies.
- Authorize payment and settlement options.
- Identifies suspicious losses and recommends referral to SIU where appropriate and may assist SIU in their investigation and settling of the claim.
Education
Bachelor of Arts - Criminal Justice
California State University - Fullerton
Fullerton, CA01.1990
Skills
- Claims Investigation/Processing
- Policy Knowledge/Understanding
- Teamwork and Collaboration
- File Management
- Insurance Claims Review
- Time Management
- Decision-Making
- Conflict Resolution
- Accident Investigations
- Coverage Determination/Assessments
- Critical Thinking
- Active Listening
Timeline
Claims Generalist Associate
Progressive Insurance Company
07.2023 - Current
Claims Examiner II
National General Insurance Co/Allstate Insurance
06.2019 - 06.2023
Bachelor of Arts - Criminal Justice
California State University - Fullerton