Eliana Mendoza
SAN ANTONIO
Summary
Analytical professional in the insurance field, known for high productivity and efficiency in task completion. Skilled in risk assessment, policy review, and regulatory compliance. Excel at problem-solving, communication, and decision-making to deliver optimal outcomes.
Overview
7
7
years of professional experience
Work History
Commercial Auto Claims
The Hartford
San Antonio
04.2024 - Current
- Worked collaboratively with team members across multiple departments; identified areas where processes could be improved.
- Worked on dedicated accounts and built working relationships with our claims, plus accounts, and CSEs.
- Researched relevant laws, regulations, legal decisions and precedents to determine appropriate course of action.
- Negotiated settlement of claims with claimants to ensure fair outcomes.
- Assisted colleagues with difficult cases; provided guidance regarding complex issues or scenarios.
- Participated in training and mentoring of new claims adjusters, sharing knowledge and expertise.
- Calculated and authorized payment of claims within designated authority level.
- Analyzed and determined fault in auto accidents based on evidence and applicable laws.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Communicated effectively with policyholders, providing updates and explaining claim processes.
- Evaluated performance metrics regularly; suggested modifications where necessary for increased efficiency.
- Managed caseload effectively, prioritizing urgent or high-value claims for prompt attention.
- Presented cases at mediations or arbitrations as needed in order to facilitate dispute resolution process.
Fraud Specialist III
J.P Morgan Chase
08.2021 - Current
- Investigate and execute data analysis and research of electronic transactions while utilizing logical thinking skills to mitigate and avoid fraud/scam losses
- Generated over 6 million in saves on the scam interruption pilot project in the last quarter of 2023
- Identified process improvement opportunities to enhance operational effectiveness and improve team productivity, resulting in a significant reduction in claims
- Coordinate with cross-functional teams to identify process gaps and develop solutions, resulting in a new scam team, more effective approach in educating customer, and improvement in our process for front line specialists
- Utilized various tools and techniques to identify and mitigate potential fraud risks
- Collaborated with crossfunctional teams to review suspicious cases by creating UAR's and SAR's to develop appropriate action plans to identify high risk accounts
- Analyzed data and trends to proactively identify potential fraud patterns and implement preventive measures
- Pioneered a new scam team within the department and acted as one of the lead SME's (subject matter expert)
- Provided training and guidance to team members on fraud detection and prevention strategies
- Communicated with customers, merchants, and financial institutions to resolve fraud related issues and disputes
- Maintained accurate records and prepared detailed reports on fraud cases and findings
- Stayed updated on industry trends and best practices in fraud prevention and detection
- Assisted in developing and updating fraud policies and procedures
- Participated in meetings and training sessions related to fraud prevention/detection and performed side by sides to new members of the scam interruption team
Toxicology lab tech
CPM Lab
01.2018 - 07.2021
- Accessioned specimens into laboratory information management system (LIMS)- entered patient information, diagnosis codes, test codes, and medications
- Managed inventory of laboratory supplies/reagents and ensured arrival of all ordered items
- Ability to detect and troubleshoot issues on Indiko and LCMS/MS instruments and perform maintenance when needed- proficient in mass spectrometry
- Conducted laboratory tests and experiments on various biological samples to identify the presence of toxic substances
- Utilized advanced laboratory equipment and techniques such as chromatography and mass spectrometry to analyze and interpret results
- Maintained accurate records and documentation of all lab procedures and results
- Collaborated with team members to develop and implement new testing methods and protocols
- Performed quality control checks to ensure accuracy and precision of results
- Followed strict safety protocols and maintained a clean and organized lab environment
- Communicated findings and results to supervisors and team members
- Assisted in the preparation and analysis of data for research projects and reports
- Conducted research on emerging toxicological trends and techniques to stay updated in the field
- Participated in proficiency testing and training to maintain proficiency in laboratory procedures and techniques
Education
B.A - Criminololgy in Forensics, Minor in Biology
St. Mary's University
San Antonio, TX05.2018
Skills
- Problem-solving
- Conflict resolution
- Time management
- Leadership
- Risk management
- Decision-making
- Multi-tasking
- Verbal communication
- Accountability
- Analytical skills
- Detail oriented
- New hire mentor
Languages
Spanish, fluent
Timeline
Commercial Auto Claims
The Hartford
04.2024 - Current
Fraud Specialist III
J.P Morgan Chase
08.2021 - Current
Toxicology lab tech
CPM Lab
01.2018 - 07.2021
B.A - Criminololgy in Forensics, Minor in Biology
St. Mary's University
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