Ericamarie Gonzalez

• Verifying an insurance policy exists for the injured person and/or property.
• Investigating property damage or personal injury accidents.
• Gathering evidence and information related to the case, including police reports and witness statements.
• Investigating questionable claims.
• Consulting with specialists, such as physicians, lawyers, engineers, and architects.
• Compiling reports of investigation findings.
• Negotiating settlements and authorizing payments.

Investigate and evaluate workers' compensation claims to determine validity, appropriate benefits, and settlement options.

• Adjust claims according to state laws and corporate claim standards, ensuring compliance at every step.

Establish reserves, and provide recommendations within established authority levels.

• Review medical, legal, and damage estimates; negotiate disputed invoices for resolution.

• Authorize and make timely claim payments using industry-standard claim systems.

• Collaborate with medical providers, attorneys, and employers to resolve complex cases efficiently.

• Maintain detailed claim files and documentation in compliance with internal and regulatory standards.

• Managed multiple claims simultaneously while adhering to deadlines and protocols.
• Negotiated settlements with claimants or their representatives in order to resolve disputes quickly and economically.

• Responsible for validating and entering information and insurance coverage into the appropriate computer system.
• Duties also include communicating with, insurance carriers, and policy holder follow-ups.
• Answers moderately complex inbound phone calls from policyholders, agents, third parties, and business partners who are inquiring about insurance products.
• Reduces customer call backs by creating a simple, hassle-free interaction for the caller.
• Participates in technical and customer service skills training to stay aware of current and best practices.
• Diagnoses customer issues at a developing level. Provides solutions and uses a structured thought process to achieve results while balancing customers’ needs with company guidelines.
• Majority of calls will be moderate but may take overflow of complex calls if necessary.