Delma Gonzales
San Antonio,TX
Summary
Results-driven Third Party Injury Claim Adjuster with proven skills in claims evaluation and negotiation. Expertise in regulatory compliance and effective communication, ensuring thorough investigation and resolution of complex claims.
Overview
36
36
years of professional experience
Work History
Third Party Injury Claim Adjuster
USAA
San Antonio, Texas
02.2009 - 02.2025
- Evaluated claims to determine coverage and liability issues.
- Investigated incidents by gathering evidence and interviewing stakeholders.
- Collaborated with legal teams to resolve complex claim disputes.
- Documented findings in detailed reports for review and processing.
- Communicated effectively with policyholders throughout the claims process.
- Utilized claims management software for efficient tracking and documentation.
- Maintained detailed records of all claim activities in a timely manner.
- Ensured compliance with regulatory requirements relating to claims handling.
- Assessed potential losses for insureds in accordance with applicable laws and regulations.
- Negotiated total loss settlements by reasonably applying company estimates to benefit both client and company needs.
- Reviewed property damage estimates for accuracy and completeness.
- Investigated insurance claims to determine liability and damages.
- Established reserves for each claim based on analysis of the facts and applicable law.
- Provided coverage opinions based on analysis of facts, law, policy language and endorsements.
Claims Case Manager
Liberty Mutual Insurance/Wausau/Nationwide
San Antonio, Texas
07.1989 - 02.2009
- Managed claims processing for personal and commercial insurance policies.
- Evaluated claim validity based on policy coverage and applicable laws.
- Utilized claims management software to track case progress and documentation.
- Negotiated settlement agreements between claimants and insurance companies when necessary.
- Monitored claim status to ensure timely processing of payments.
- Facilitated dispute resolution between claimants and insurance companies through mediation when possible.
- Investigated and resolved discrepancies related to claims processing.
- Reviewed and evaluated claims for accuracy, completeness and compliance with established procedures.
Education
Associate of Arts - Insurance And Risk Management
American Education Institute
03-2013
Skills
- Claims evaluation
- Liability assessment
- Claims negotiation
- Investigative techniques
- Regulatory compliance
- Customer relationship management
- Effective communication
- Case documentation
- Problem solving
- Claims investigation
- Tme management
- Customer service
- Insurance policy coverage expertise
- Verbal and written communication
- Empathy and patience
- Highly motivated
Timeline
Third Party Injury Claim Adjuster
USAA
02.2009 - 02.2025
Claims Case Manager
Liberty Mutual Insurance/Wausau/Nationwide
07.1989 - 02.2009
Associate of Arts - Insurance And Risk Management
American Education Institute
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