Donna Archuleta
Chandler,AZ
Summary
Claims Specialist with extensive experience at State Farm Insurance, specializing in claims management and fraud detection. Demonstrated success in negotiating settlements and ensuring regulatory compliance. Skilled in conducting thorough accident investigations and making effective decisions in high-pressure situations. Focused on achieving exceptional results in claims processing.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Claims Specialist Tier II
State Farm Insurance
Tempe, AZ
04.2023 - 04.2024
- Examined automobile policies with third-party liability, accident benefits, and collision benefits.
- Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
- Negotiated settlements with claimants and attorneys within authorized limits.
- Maintained up-to-date knowledge of insurance laws and regulations.
- Conducted interviews with involved claims parties and witnesses to gather detailed information and arrange investigations.
- Analyzed and interpreted policy terms to apply appropriate coverage.
- Processed payments for valid claims according to established procedures.
- Communicated effectively with policyholders to explain claims processes and outcomes.
- Drafted statements of loss to summarize damages, payments and underlying policy coverages.
- Evaluated claims for potential fraud and took appropriate actions.
- Facilitated communication between claimants, providers, attorneys, adjusters, employers, and other parties involved in a claim.
- Calculated and authorized payment of claims within specified limits.
- Managed a caseload of claims efficiently, ensuring adherence to company standards.
- Coordinated and planned investigations of claims to confirm compensability and coverage.
Auto Claims Associate
State Farm
Tempe, AZ
01.2018 - 04.2023
- Prepared detailed documentation outlining findings from investigations into auto accidents or other losses.
- Negotiated settlements with claimants or their representatives when necessary.
- Processed payments for approved claims according to established guidelines.
- Monitored expenses associated with each claim to ensure they stayed within budget guidelines.
- Assessed the validity of claims and determined appropriate action based on policy provisions.
- Assisted in training new staff members on procedures related to processing auto claims.
- Conducted investigations, gathered evidence, and interviewed witnesses to determine liability in auto accident cases.
- Communicated with policyholders to explain claim decisions and answer inquiries.
- Entered claim information accurately into database systems.
- Identified and flagged suspicious claims for further investigation.
- Followed up on pending claims and resolved issues delaying processing.
Education
Associate of Applied Science - Radiology
Pima Medical Institute
Mesa, AZ04-2021
Skills
- Claims management and fraud detection
- Compliance with regulations
- Knowledge of insurance policies
- Resolution of conflicts
- Effective decision-making
- Research capabilities
- Adaptability
- Multitasking Abilities
- Accident investigations
- Insurance coverage limits
Certification
- Adjuster License in the following states;
- KY
- LA
- NC
- NH
- NM
- OK
- SC
- TX
- VT
Timeline
Claims Specialist Tier II
State Farm Insurance
04.2023 - 04.2024
Auto Claims Associate
State Farm
01.2018 - 04.2023
Associate of Applied Science - Radiology
Pima Medical Institute
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