HELEN TOLEDO
Miami
Summary
Detailed Insurance Clerk and Customer service representative with over 6 years of experience and is commitment to organization, service and professionalism. Excellent computer and communication skills with exceptional knowledge of automobile insurance policies. Connects with clients easily to provide thoughtful and compassionate assistance. Manages client files and prioritizing tasks to achieve optimal productivity. Professional Objective: To obtain a position in my field where I can utilize my skill set, and leverage my communication skills to help build the success of the company.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Claims Representative /Subrogation Claims Representative
The Claims Center
11.2022 - Current
- Negotiated favorable settlements with claimants, resulting in cost savings for the company.
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Analyzed and addressed escalated claims to resolve issues quickly.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Negotiated claim settlements with claimants and attorneys to resolve claims efficiently and fairly.
Public Adjuster (Seasonal-Only 5 Months)
Elite Claims Consultant
05.2022 - 09.2022
- Examined claims forms and other records to determine insurance coverage.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Answered customer questions regarding deductibles.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Organized, planned, and documented materials for roof wind/hail claims.
Customer Service/Property Damage Adjuster
United Automobile Insurance Company
11.2021 - 05.2022
- Verified and updated customer contact details in Guidewire to build and maintain and accurate customer database.
- Submitted claims and initiated damage appraisal to facilitate the claims process for policyholders.
- Documented customer contact in Guidewire to maintain a record of customer interactions and elevate quality of service.
- Adhered to underwriting, rating, and compliance criteria and guidelines to determine associated financial risks.
- Answered incoming phone calls to articulate product value to prospective customers and support current policyholders.
- Provided ongoing guest service.
- Investigated claims by reviewing policy contracts to determine claim coverage based on cause and facts of loss.
- Carefully reviewed claim information to verify accuracy and avert fraudulent claims.
- Examined claims forms and other records to determine insurance coverage.
Physician Liaison/ Intake Coordinator
Vohra Wound Physicians
11.2020 - 06.2021
- Successfully completes all training and onboarding requirements with 300 physicians.
- Including analytics and Point Click Care system Ensuring efficient wound rounds between physicians and nursing staff Maintains relationships with physicians to drive patient volume, enhance customer loyalty and exceed patient satisfaction by 21%.
- Extensive knowledge of using EMR systems, NEXTGEN & SALESFORCE platforms.
- Effectively completing 30-40 daily calls and 20 or more emails to skilled nursing facilities, assisted living facilities, and staff to coordinate patient referrals into Vohra’s admin portal platform.
- Worked with clinical and operations teams to facilitate client placement and obtain appropriate services for clients.
- Monitored front areas so that any questions could be responded to quickly and effectively.
Education
Florida All Lines Insurance Adjuster License - Insurance
Miami Dade College
Miami, FL03.2022
Associate of Arts - Physical Therapy
Miami Dade College
Miami, FL06.2020
High School Diploma -
Hialeah Senior High School
Hialeah 06.2017
Skills
- Microsoft Office Suite
- Multitasking and Prioritization
- Project Management
- Policy understanding
- Patient contact
- Understanding of medical terms
- Documentation abilities
- Reporting skills
- Insurance industry experience
- Good Telephone Etiquette
- Guidewire Proficient
- Understanding Customer Needs
- Calm and Professional Under Pressure
- Computer Proficiency
- Inbound and Outbound Calling
- Xactimate Proficient
- JobNimbus Proficient
Certification
Florida All Lines Adjusters License (6-20)
3-20 Public Adjuster License
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Claims Representative /Subrogation Claims Representative
The Claims Center
11.2022 - Current
Public Adjuster (Seasonal-Only 5 Months)
Elite Claims Consultant
05.2022 - 09.2022
Customer Service/Property Damage Adjuster
United Automobile Insurance Company
11.2021 - 05.2022
Physician Liaison/ Intake Coordinator
Vohra Wound Physicians
11.2020 - 06.2021
Florida All Lines Insurance Adjuster License - Insurance
Miami Dade College
Associate of Arts - Physical Therapy
Miami Dade College
High School Diploma -
Hialeah Senior High School
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