Summary
Overview
Work History
Education
Skills
Certification
Languages
Affiliations
Timeline
Generic

Gabriela Cuellar

Mission,Texas

Summary

Dynamic Claims Adjuster with expertise in claims investigation and fraud detection at Quantum Alliance. Proven ability to assess liability and manage complex claims, delivering exceptional customer service. Skilled in policy interpretation and fostering strong relationships with stakeholders, ensuring fair and prompt settlements while maintaining high standards of accuracy and integrity.

Overview

6
6
years of professional experience
1
1
Certification

Work History

Claims Adjuster

Quantum Alliance
Rockwall, Texas
05.2022 - Current
  • Calculated and authorized payment of claims within designated authority level.
  • Conducted interviews with claimants, witnesses and medical professionals to obtain additional information about the claim.
  • Worked closely with repair facilities and contractors to ensure quality repairs for policyholders.
  • Gathered information from various third parties to determine claim acceptability.
  • Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
  • Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
  • Communicated effectively with policyholders, providing updates and explaining claim processes.
  • Utilized computer systems such as Microsoft Office Suite and specialized software programs used by the company.
  • Investigated and evaluated property and casualty insurance claims to determine coverage and liability.
  • Determined reserves for each claim based on estimated costs of settlement or defense.
  • Investigated potentially fraudulent claims with focus on thoroughness, quality, and cost control.
  • Ensured timely follow-up on all open matters; kept stakeholders informed regarding status updates.
  • Interpreted policy language to determine coverage for insureds under various lines of business.
  • Verified liability extent with reviews of police reports, medical treatment histories and other records.
  • Managed caseload effectively, prioritizing urgent or high-value claims for prompt attention.
  • Discussed current cases and issues in claim committee meetings.
  • Analyzed facts of loss including photographs, diagrams and other evidence to identify potential sources of recovery.
  • Attended continuing education classes in order to stay abreast of changes in industry standards.
  • Utilized claim handling software to document and manage claim files efficiently.
  • Interviewed claimants, medical specialists and employers to determine pertinent claim information.
  • Analyzed and determined fault in auto accidents based on evidence and applicable laws.
  • Researched relevant laws, regulations, legal decisions and precedents to determine appropriate course of action.
  • Reviewed and applied state laws and regulations to ensure compliance in claim handling.
  • Developed relationships with attorneys, experts and vendors in order to ensure prompt service when necessary.
  • Investigated questionable claims to determine payment authorization.
  • Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
  • Investigated insurance claims, reviewed coverage and liability, prepared reports and recommended payment or denial of claims.
  • Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
  • Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
  • Approached customers and engaged in conversation through use of effective interpersonal and people skills.
  • Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
  • Drafted statement of loss to summarize damages, payments and underlying policy coverage.
  • Prepared detailed reports on investigation findings and claim status for internal use.
  • Identified and obtained evidence to ascertain claim value.

Personal Assistant

Mission Pediatric Center
Mission, Texas
03.2019 - 04.2022
  • Assisted in the hiring and onboarding process of new staff, providing training and support as needed.
  • Ran errands to help with daily tasks, enabling employer to focus on more pressing duties.
  • Managed expense reports, including tracking receipts and processing reimbursements promptly.
  • Completed basic administrative work and managed household accounts.
  • Scanned physical documents and uploaded to encrypted databases for digital maintenance.
  • Answered incoming calls and emails promptly while managing the executive's schedule accordingly.
  • Booked flights, hotel accommodations and ground transportation for smooth business travel.
  • Handled confidential documents and communications with discretion, safeguarding sensitive information.
  • Managed and prioritized daily schedules, ensuring efficient allocation of executive's time.
  • Compiled weekly progress reports highlighting key accomplishments from past week's activities.
  • Assisted with special projects as needed by researching topics, organizing data, summarizing findings.
  • Performed various clerical tasks and organized office areas to promote productivity.
  • Screened telephone calls and inquiries and directed as appropriate.
  • Submitted reports to and reviewed reports with supervisor.
  • Maintained confidential files related to personnel records or other sensitive information.
  • Maintained clerical correspondence via email and phone.
  • Scanned documents into electronic format for storage in a secure database system.
  • Provided personal support to the executive, including errand running and personal shopping.
  • Provided assistance communicating, typing correspondence or obtaining information.
  • Coordinated meeting and work schedules for staff teams and executives.
  • Organized and maintained digital and physical filing systems for easy access and retrieval of documents.
  • Kept patient health and personal information private and confidential.
  • Processed invoices related to business expenses incurred by the executive team.
  • Coordinated travel arrangements, including flights, accommodations, and itineraries, for both business and personal trips.
  • Organized both physical and digital files and updated reports to coordinate project materials.
  • Facilitated smooth internal and external communication, acting as the first point of contact for the executive.
  • Assisted in planning and coordinating events, from small meetings to large corporate gatherings.
  • Performed calendar management and scheduling of appointments for the executive.
  • Proofread documents for accuracy prior to submission to the executive team.
  • Scheduled and confirmed appointments, preventing scheduling conflicts and optimizing time management.
  • Utilized technology efficiently, including MS Office and CRM systems, to enhance productivity and organization.
  • Prepared documents such as reports, presentations, agendas, and correspondence.
  • Oversaw household management tasks, including coordinating with service providers and managing schedules.
  • Sorted mail received daily for distribution throughout the office.
  • Greeted visitors in a professional manner and provided assistance with inquiries.
  • Managed office supplies inventory and placed orders when necessary.
  • Organized personal and professional calendars with reminders for upcoming meetings and events.
  • Coordinated with other staff members to ensure seamless support and coverage.

Education

MEDICAL OFFICE SPECIALIST - MEDICAL

KAPLAN COLLEGE
TEXAS
05-2009

Some College (No Degree) - Liberal Arts

Ridgewater College
Willmar, MN

Skills

  • Claims investigation
  • Policy interpretation
  • Fraud detection
  • Liability assessment
  • Claims management
  • Customer service

Certification

  • INSURANCE AGENT LICENSE
  • CLAIMS ADJUSTER LICENSE
  • PUBLIC NOTARY LICENSE

Languages

Spanish
Professional
English
Professional

Affiliations

  • SUNDAY PRESCHOOL TEACHER AT BT CHURCH

Timeline

Claims Adjuster

Quantum Alliance
05.2022 - Current

Personal Assistant

Mission Pediatric Center
03.2019 - 04.2022

MEDICAL OFFICE SPECIALIST - MEDICAL

KAPLAN COLLEGE

Some College (No Degree) - Liberal Arts

Ridgewater College

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