JANET GONZALEZ
Homestead,FL
Summary
Highly motivated Licensed Insurance Professional with over 22 years of experience. I bring a strong background in the insurance industry in search of new opportunity with potential for growth. I am skilled in investigating claim, processing and settling claims, analyzing data, and resolving complex issues efficiently. Known for reliability and adaptability in dynamic environments. Equipped with excellent communication, negotiation, and problem-solving abilities.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Claims Litigation Specialist
NFIP Direct
01.2024 - Current
- Conduct full investigation to ensure all documents were in the I file and uploaded to FEMA cloud vault. I assigned the claim for Litigation and notified the examiner and vendors no further action can be made.
- Conducted investigations, analyzed and evaluated the full claim file to provide our legal counsel payment recommendation for possible settlement.
- I make coverage determinations and communicate written position(s) to insureds and other required parties.
- Set appropriate expense, reserves and monitored on a regular basis for any needed adjustment.
- Developed and implemented resolution strategies to achieve high quality outcomes.
- Proactively engaged with FEMA counsel on litigation planning budgeting and bill review.
- Attended mediations as necessary.
- Reviewed, investigated and responded to all FEMA Appeals, Congressional Complaints, Better Business Complaints, Social Media Complaints and Department of Insurance Complaints.
- Prepared comprehensive reports and delivered presentations to Senior Management on case developments, policy issues, industry trends on a monthly basis.
- Provide support to the adjusting firms and examiner on coverage analysis, time limit demands, extra contractual exposure evaluations and other issues of complexity.
- Work with business partners including however not limited to Adjusting firms, Engineer firms and Certified Public Accountants to evaluate and address claim trends and developments.
- Strengthen agent and policyholder relationships by addressing inquiries, presenting claim status updates, and providing superior customer service.
- Assisted on all escalated files.
- Provided training to the staff on recent trends in litigations and provided clarification on all new guidelines or bulletin released by FEMA.
- Manually assigned claims to our partners and examiners.
- Processed approval for the staff examiner and outside examiners with up to 1 million in authority.
- Participated in FEMA monthly review and provided the information to the staff.
- Manage staff by load balancing, assisted in complex file, authorizing vendor request, submitting FEMA waiver request, submitting Salae request, auditing the files for approval and providing directive on to proceed to conclusion.
- Reviewed and provided responses to RCQC performed by FEMA
- Reviewed and provided response to our internal audit reviews.
- Worked with senior leadership to develop contingency planning for large scale catastrophic losses and build on going relations with Adjusting firms.
- I process all settlement agreement payment ensuring file is properly documented and required releases are received in file.
Senior Property and Casualty Claims Adjuster
Assurant
07.2015 - Current
- Conducted thorough investigations and made coverage determinations based on policies in force and contractual agreements.
- Educated customers, agents, third parties on the policies and coverages and reporting progress throughout the claim process.
- Developed and maintained effective working relationship with vendors, partners, specialists, external and internal resources
- Gathered, reviewed and organized field data for analysis and recommendations.
- Ensured federal and state guidelines are followed throughout the processing.
- Onboarding, training and offering continuous advice, guidance and mentorship for new hires and peers.
- Recognized and referred where potentials for fraud, subrogation or salvage were determined.
- Managed and delivered on high volume with average pending at 150 claims.
- Large loss specialist determining coverage on Private Flood and NFIP claims.
- Approved claim files within my authority and submitted recommendations for upper management if above my authority
- Secured FEMA required waivers to meet compliance
- Assigned vendors and obtained FEMA authorization when necessary
- Reviewed insured complaints, appeals, DOI complaints, BBB complaints, FEMA GA Assist and Congressional compliant and taking necessary actions.
Benefits Manager
Aetna
02.2014 - 07.2015
- Reviewed and analyzed medical records and exam results to identify objective findings.
- Compared medical records to MDA Guidelines to support a reasonable duration. Educated claimants on plan specific ensuring to adhere to plan exclusions. Partnered with medical professional, behavior specialist and legal counsel for third party independent review.
- Documented all calls with activities and determinations. Maintained contact with claimants and employer to advise of status. Answered customer questions regarding plan specific.
- Answered questions posed by insured, attorneys and medical professional.
- Prepared files to transition claimant from short term disability to long term disability working with FMLA and each State disability department
Senior Account Manager
Robin Lewis Insurance Organization
06.2006 - 02.2014
- Closed an average of 20 new sale of policies per week.
- Calculated premiums and established payment methods for sales. Identified and solicited sales prospects in agency databases. Met with policyholders to address and resolve complaints.
- Met with existing and prospective clients each week to select appropriate insurance policies.
- Modeled exceptional customer service skills and appropriate sales techniques.
- Negotiated new and renewal production goals with business development manager.
- Contributed ideas and offered constructive feedback at weekly sales and training
- Calculated quotes and educated potential clients on insurance options.
- Created internal workflows for associates
- Interviewed potential employees and assisted in the hiring process.
- Networked and solicited business
- Trained new hires on new process
Insurance Agent
FedUSA
03.2003 - 06.2006
- Calculated premiums and established payment methods for sales.
- Modeled exceptional customer service skills and appropriate diagnostic sales techniques.
- Collected all premiums on or before effective date of coverage.
- Contributed ideas and offered constructive feedback at weekly sales and training meetings.
- Calculated quotes and educated potential clients on insurance options.
- Promoted ancillary products to existing and new clients each month.
- Followed up with customers on unresolved issues.
- Reported policy changes and company conditions affecting customer satisfaction.
- Collected, analyzed and validated all agency commissions.
Store Activity Director
McDonalds
06.2000 - 03.2003
- Managed company leadership training programs.
- Developed business relationships with Corporation promoting our Brand.
- Scheduled weekly inventory pickups and deliveries with vendors.
- Handled daily employee work schedule ensuring location was fully staffed.
- Completed inventory every month and reviewed cash operation data daily to verify proper replenishment.
- Assisted customers with food selection, inquiries and order customization requests.
- Built long-term customer relationships and advised customers on purchases and promotions.
- Ensured all pricing and promotions were current
- Created monthly activities to drive business to the store
Education
Bachelor of Art - Psychology
Florida International University
Miami, FL01.2017
Associate of Arts - undefined
Broward College
Fort Lauderdale, FL01.2011
Skills
- Claims expert in investigating and adjusting claims
- Settlement negotiation
- Client communication
- Large loss specialist
- Flood subject matter expert
Certification
- FCN # 0070010642
- All Line Adjuster # E081753
Timeline
Claims Litigation Specialist
NFIP Direct
01.2024 - Current
Senior Property and Casualty Claims Adjuster
Assurant
07.2015 - Current
Benefits Manager
Aetna
02.2014 - 07.2015
Senior Account Manager
Robin Lewis Insurance Organization
06.2006 - 02.2014
Insurance Agent
FedUSA
03.2003 - 06.2006
Store Activity Director
McDonalds
06.2000 - 03.2003
Associate of Arts - undefined
Broward College
Bachelor of Art - Psychology
Florida International University
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