Elena Moronta
Port Richey,FL
Summary
Experienced and motivated Claims Representative with over 20 years of experience in the automobile insurance industry. Recognized consistently for performance excellence and contributions to success. Business-minded with exemplary skills in customer service, leadership, time management and service coordination.
Overview
14
14
years of professional experience
1
1
Certification
Work History
APD CLAIMS REPRESENTATIVE II
AAA
Tampa, FL
03.2023 - Current
- Review assigned claims, contact the insured and other affected parties, set expectations for the remainder of the claim, and initiate documentation in the claim handling system.
- Complete coverage analysis including a review of policy coverages and provisions, and the applicability to the reported loss.
- Ensure all possible policyholder benefits are identified, create additional sub-claims if needed or refer complex claims to management or the appropriate claim handler.
- Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
- Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
- Evaluate the financial value of the loss.
- Approve payments for the appropriate parties accordingly.
- Refer claims to other company units when necessary
CLAIMS CUSTOMER SERVICE REPRESENTATIVE
AAA
Tampa, FL
11.2020 - 03.2023
- Answered incoming phone calls to provide claims status and assist with the set up of new claims
- Reviewed and adjusted customer coverage levels to address, identify and resolve customer conflicts
- Responded to customer requests for products, services and claims handling resolve
- Assisted management with the training of new hires and continued mentoring as needed.
ARBITRATION SPECIALIST (TEMP-JOB)
Arbitration Forums, Inc.
Tampa
01.2020 - 06.2020
- Reviewed the evidence presented by each insurance carrier to resolve Auto Property Damage Claims
- Made determinations based on the evidence submitted
- Attended training programs to deepen professional skillset.
CLAIMS SUPERVISOR
Windhaven Insurance Company, Inc.
Tampa
12.2013 - 01.2020
- Initially hired as a Property Damage Claims Adjuster
- Handled and resolved all aspects of this field
- From Initial Coverage Review, first and third party claims, comparative negligence claims, total loss and subrogation
- Promoted and became their Certified Arbitration Specialist
- In this role, I held a successful win rate of 98% from third party claims filed against the company inclusive of filing first party claims on behalf of the company
- Promoted to become their EUO Processing team Supervisor
- Confirmed coverage was afforded accurately along with adjuster's submission of a coverage denial based on a Material Misrepresentation discovered
- Assured all required letters were mailed out and in a timely manner
- Assured phone standards were in compliance and proper diary of files were kept
- Managed all daily, weekly and monthly metrics for compliance
- Promoted to PIP Claims Supervisor
- In this department, I managed adjuster's qualifications for accuracy or denial of coverage when applicable
- Managed the accuracy of payments being issued to medical providers, monetary compensation to insured's for loss wages or mileage reimbursement
- Adjusted reserves
- Assured required letters and templates were being uploaded to the file
- Check approval, assured their daily closure goals were being met, daily bills processed were being met and providing constant feedback on audits.
AUTO CLAIMS SUBROGATION SPECIALIST
United Automobile Insurance Company
Miami, FL
05.2010 - 11.2013
- Responsible for the subrogation claims of 7 different states
- Examined photographs and surveillance and any other documents relating to claims
- Negotiated with claimants and insurance companies to settle claims
- Determining if there is comparative negligence based on the state
- Referral sent to litigation when applicable.
Skills
- Knowledge of compliance requirements
- Ability to achieve goals in timely manner
- Time management skills
- Results-driven
- Arbitration and Litigation
- Strong analytical skills and attention to details
- Strong communication skills
- Management Experience
Certification
- Arbitration Forums, Inc
- All lines 620 licensed
Languages
- English
- Spanish
Timeline
APD CLAIMS REPRESENTATIVE II
AAA
03.2023 - Current
CLAIMS CUSTOMER SERVICE REPRESENTATIVE
AAA
11.2020 - 03.2023
ARBITRATION SPECIALIST (TEMP-JOB)
Arbitration Forums, Inc.
01.2020 - 06.2020
CLAIMS SUPERVISOR
Windhaven Insurance Company, Inc.
12.2013 - 01.2020
AUTO CLAIMS SUBROGATION SPECIALIST
United Automobile Insurance Company
05.2010 - 11.2013
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