Jaslyn Jimenez
Hopewell Junction ,NY
Summary
Seasoned Claims Specialist with comprehensive background in insurance claim processing, policy interpretation, and dispute resolution across various states. Have successfully managed complex and high-volume claims environments, while staying organized under pressure. Known for strong analytical skills and consistently ensuring prompt, fair settlements while maintaining compliance with industry regulations.
Overview
18
18
years of professional experience
7
7
years of post-secondary education
Work History
Claims Specialist III, Casualty Litigation
Nationwide Insurance Company
Elmsford, New York
10.2015 - Current
Claims Specialist II, Casualty Bodily Injury
Nationwide Insurance Company
Elmsford, NY
03.2015 - 10.2015
- Investigated attorney represented bodily injury claims in NY
- Completed liability investigations by ordering police reports, doing scene investigations, and taking recorded statements from involved parties and witnesses
- Followed up with attorneys and no fault providers to get up-to-date information on injuries and treatment
- Evaluated medical records and bills to reach an agreed settlement on a bodily injury claim with the handling attorney
- Followed up with the handling attorney to secure all closing paperwork and refer claims to a litigation specialist if suit is filed
- Referred claims to Special Investigation Unit as warranted
- Analyzed claim documentation to determine eligibility and coverage.
Claims Specialist I, Casualty Bodily Injury
Nationwide Insurance Company
Elmsford, NY
08.2014 - 03.2015
- Investigated pro se bodily injury claims in NY
- Investigated claims to determine liability
- Ordered police reports, did scene investigations, took recorded statements from involved parties and witnesses, and negotiated settlements with claimants or his/her attorney
- Served as the frontline individual in uncovering any fraudulent activity in claims and submitted them for further investigation to the Special Investigation Unit
- Evaluated medical bills to determine if the individual’s injury qualifies as serious or permanent based on NYS Threshold and discussed settlement
- Determined if there was a trigger for an underinsured/uninsured claim and referred that portion of the claim to that department for continued handling
Bodily Injury Claims Adjuster
Allstate Insurance Company
Fishkill, NY
11.2007 - 08.2014
- Investigated property damage and bodily injury claims involving pro se individuals, attorney represented individuals and litigated cases in NY
- Investigated liability
- Ordered police reports, did scene investigations, took statements from involved parties and witnesses, and negotiated settlements with claimants or third party carriers.
- Served as the frontline individual in uncovering any fraudulent activity in claims and submitted them for further investigation to the Special Investigation Unit
- Evaluated medical bills to determine if the individual’s injury qualifies as serious or permanent based on NYS Threshold and discussed settlement with the claimant or his/her attorney
- Partnered with our counsel and the plaintiff’s attorney on cases that were in litigation
Education
Master's Degree - English Language Arts
University of Phoenix
Phoenix, AZ 05.2007 - 06.2009
Bachelor’s Degree - Special and General Education
Marist College
Poughkeepsie, NY 08.2002 - 05.2007
Skills
- Claims investigation
- Medical record evaluation
- Settlement negotiation
- Fraud detection
- Effective communication
- Detail orientation
- Time management
- Team collaboration
- Settlement coordination
- Complex claims consulting
- Policy interpretation
- Coverage assessments
- Adaptability
- Relationship building
- Analytical thinking
- Excellent communication
References
Available upon request
Languages
Spanish, Fluent
Timeline
Claims Specialist III, Casualty Litigation
Nationwide Insurance Company
10.2015 - Current
Claims Specialist II, Casualty Bodily Injury
Nationwide Insurance Company
03.2015 - 10.2015
Claims Specialist I, Casualty Bodily Injury
Nationwide Insurance Company
08.2014 - 03.2015
Bodily Injury Claims Adjuster
Allstate Insurance Company
11.2007 - 08.2014
Master's Degree - English Language Arts
University of Phoenix
05.2007 - 06.2009
Bachelor’s Degree - Special and General Education
Marist College
08.2002 - 05.2007