Delmi Bacasegua
Summary
Skilled in handling complex insurance claims and policy processing with experience in navigating through various insurance software systems. Demonstrates strong analytical skills, adept at interpreting policies and efficiently resolving claims to the satisfaction of all parties involved. Known for maintaining high accuracy levels in document processing and data entry, contributing to streamlined operations and improved customer service outcomes. Continuously seeks ways to optimize workflows and enhance team productivity, leading to more efficient claim resolution processes.
Overview
5
5
years of professional experience
Work History
Claim Specialist
State Farm
Tempe, AZ
04.2023 - Current
- Advised claimants on available benefits under their policy coverage.
- Provided excellent customer service throughout the entire claims process.
- Reviewed policies and procedures regularly to ensure they are up-to-date with industry standards.
- Conducted periodic reviews of closed files to ensure compliance with state regulations and company guidelines.
- Attended continuing education courses related to insurance regulations and best practices.
- Resolved difficult issues promptly while maintaining a high level of professionalism.
- Identified potential fraud indicators and escalated to appropriate personnel for further investigation.
- Developed effective relationships with customers through communication via phone or email.
- Determined liability according to applicable laws and coverage provisions.
- Reviewed incoming claims for accuracy and completeness in accordance with policy provisions.
- Investigated, evaluated, and negotiated settlements of assigned claims.
- Responded to inquiries from claimants, attorneys, medical providers. regarding the status of their claim.
- Maintained timely and accurate records of all claim activity.
- Processed payments accurately according to established timelines.
- Determined liability, compensability, and benefits due on each claim.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
- Examined claims, records and procedures to grant approval of coverage.
- Drafted statements of loss to summarize payments, underlying policy coverages and damages.
Claims Associate
State Farm
Tempe, AZ
07.2021 - 04.2023
- My duties as a claims associate included reviewing a customer's policy coverage, and interviewing those who filed a claim. My job was to insure that a claim can be processed correctly, so the insure is taking care of, as well of the claimant.
- Interacted with clients via telephone, email, or in person to discuss claim status and provide updates.
- Resolved customer complaints related to denied or delayed claims in a professional manner.
- Determined liability, compensability, and benefits due on each claim.
Colections Represantative
Regional Acceptance
Phoenix, AZ
06.2020 - 07.2021
- Negotiated repayment terms with customers in accordance with company policy.
- Monitored delinquent accounts for timely payment resolution.
- Processed payments received by mail, phone or online transactions.
- Responded promptly to customer inquiries regarding their accounts status.
- Contacted customers to discuss and resolve past due accounts.
- Processed payments over phone and set up recurring drafts.
- Negotiated credit extensions to assist customers in paying overdue accounts.
- Received payment and posted to appropriate customer accounts.
- Remained calm, stayed professional, and provided exceptional service on calls, even when interacting with difficult individuals.
- Reviewed accounts to determine payment plan compliance.
Education
High School Diploma -
South Mountain High Schol
Phoenix, AZ05-2006
Skills
- Customer Service & Claims Processing
- Microsoft Word, Excel, Outlook
- Liability Assessment & Negotiation
- Data Entry & Documentation
- Call Center Operations
- Working Knowledge of applying State Statutes when setting claims
Languages
Spanish
Native/ Bilingual
Timeline
Claim Specialist
State Farm
04.2023 - Current
Claims Associate
State Farm
07.2021 - 04.2023
Colections Represantative
Regional Acceptance
06.2020 - 07.2021
High School Diploma -
South Mountain High Schol
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