Jennifer Villeta
Las Vegas,NV
Summary
Successful at managing high caseloads in fast-paced environments. Organized and adaptable with excellent time management and problem-solving abilities. Willingness to take on any challenge. Articulate, decisive, analytical, focused and motivated to make a positive impact on business operations and client satisfaction. Passionate about helping and empowering others through service. Highly driven to continue learning and evolving as a professional.
Overview
15
15
years of professional experience
Work History
Remote Special Projects Claims Lead Adjuster
Elevance Health
Las Vegas, NV
06.2023 - 08.2024
- Improved claim processing efficiency by conducting thorough investigations and promptly addressing discrepancies.
- Enhanced provider satisfaction by providing timely updates and effectively resolving claim processing.
- Streamlined workflow for faster claim resolution by coordinating with various internal departments.
- Maintained knowledge of claim bill types, procedure codes, diagnosis codes, payment codes, bypass and override codes, consent forms, place of treatment, payment eligibility codes, modifiers, the DMHC and DHCS, claims system processes and errors.
- Provided support to Special Projects’ team adjusters on project issues and resolution.
- Facilitated training on various claim types including Medicaid, COB, Skilled Nursing Facility, Community Outreach/Coordination, Outpatient, Long Term Care, SOC, and Correspondence.
- Took full ownership of investigating and researching issues to accurately process payment or denials on claims such as resolving edits, verifying EOB and other eligibility, manual pricing, incorrect denials, duplicate claims, authorizations, additional payments and interest due.
- Running spreadsheets through claims processing system and reviewing results.
- Processing all fallout claims from claims processing system runs.
- Reviewing requests in Jira and determining appropriate directions for each project.
- Maintaining and updating project tracker for Special Projects.
- Transferring project requests to excel spreadsheets and assigning to Special Projects adjusters.
- Coaching and leading meetings for Special Projects team adjusters and reviewing audit findings with each adjuster.
- Providing claims data and statuses for PDR, compliance and claims director requests.
- Handling project requests with up to 9000 claims.
Remote Bilingual Claims Adjuster
CSAA Insurance Group
Las Vegas, NV
02.2022 - 08.2022
- Temporarily hired and trained during the launch and internal training of company’s new commercial product.
- Taking first notice of losses, reviewing coverages and setting up services (method of inspection and rentals). Processing/recording new claims.
- Setting up inspections at direct repair network shops or towing & PDA assignments as necessary.
- Informing customers of potential total loss.
- Setting up rental reservations with Enterprise and Hertz.
- Taking recorded statements in case of possible liability disputes.
- Assisting in handling claim when owning adjuster is unavailable.
- Setting up glass only claims to Safelite.
- Setting up stereo only or tire only claims to Premiere Services.
- Taking calls from AAA customers, claimants, adverse carriers, body shops, towing, attorneys and medical personnel.
- Opening all necessary exposures ie; bodily injury, property damage, collision and comprehensive, etc.
- Maintaining and handling to completion a large volume of files and assigned claims. (Approx. 300+ claims with multiple files/assignments per claim).
- Responsible for investigating and concluding liability with all parties.
- Reviewing total losses and concluding with customers.
- Negotiating storage/towing fees with shops and tow yards, negotiating liability percentages with adverse.
- Triaging injury portion of claims to casualty specialists.
- Calculated & issued reimbursement checks ie. car seats, tires & glass replacement, out of pocket rentals, etc.
- Keeping in compliance with DOI.
- Sending attorney acknowledgment letters when necessary.
- Submitting requests for metro accident reports and DMV search requests.
Tutor
Self Employed
Las Vegas, NV
08.2018 - 05.2021
- Collaborated with students to complete homework assignments, identify lagging skills and correct weaknesses.
- Motivated students towards learning and studying to build self-confidence and reduce fear of failure.
- Supported students with helpful study habits and exam strategies.
- Provided homework assistance using specific curriculum and materials.
- Identified learning needs and implemented fun and engaging learning activities to help students advance.
Bilingual Commercial Auto Claims Adjuster
TEN Group
Las Vegas, NV
08.2016 - 08.2018
- Worked a large volume of commercial auto claims from simple to complex losses as a white label for rental vehicles provided to ultra high net worth clientele.
- Entrusted to handle confidential and sensitive situations in professional matter.
- Examined claims forms and other records to determine insurance coverage.
- Identified suspicious losses and worked with SIU for investigative assistance.
- Documented all investigation activity and presented reports to management.
- Resolved complex, severe exposure claims using high service oriented file handling.
- Negotiated with all parties to reach mutually satisfactory resolutions.
- Prepared summaries of damage, payments, and policy coverage.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Investigated and assessed damage to property and reviewed property damage estimates for approval or denial.
- Negotiated settlement agreements to resolve disputes.
- Worked closely with attorneys, medical staff and other third parties.
- Determined liability, total losses and reimbursement with assigned team.
- Conducted interviews and recorded statements when necessary.
Assistant Sales Floor Manager
Kalifano Gemstones
Las Vegas, NV
03.2011 - 08.2015
- Led a team of sales representatives, providing guidance, training, and support to ensure sales targets are met and exceeded.
- Ordering inventory, receiving, shipping, faxing, maintaining clientele book including emailing clients and mailing thank you letters. Performing client follow ups & check ins.
- Receiving stock from warehouse.
- Handling all inquiries on company's social media account.
- Oversaw employee performance, corrected problems and increased efficiency to maintain productivity targets.
- Offered hands-on assistance to customers, assessing needs and maintaining current knowledge of consumer preferences.
- Completed efficient daily opening and closing processes to prepare teams and maintain optimal financial controls.
- Oversaw supply restocking, area cleaning and product organization.
- Strengthened merchandising and promotional strategies to drive customer engagement and boost sales.
- Established and optimized schedules to keep coverage and service in line with forecasted demands.
- Trained and coached employees on fossil, gemstone and artifact policy and compliance.
- Collaborated with account management teams to ensure customer satisfaction and retention as well as attending & conducting regular sales meetings with team members to review performance, set targets, and identify areas for improvement.
Front Desk
A Better Way Insurance Agency
Las Vegas, NV
04.2009 - 06.2010
- Assisting customer’s with filing claims, taking first notice of losses from insured customers, claimants and insurance representatives and forwarding claim to the appropriate carrier.
- Reviewing customer coverage and claim action plans.
- Providing customers with claim status checks, assisting with rental reservations and extensions, scheduling inspections and submitting policy endorsements for service department.
- Greeted visitors and customers upon arrival, offered assistance and answered questions to build rapport and retention.
- Sent bill reminders, policy renewal notices and collected payments.
- Met with customers to provide information about available products and policies.
- Conducted annual reviews of existing policies to update information.
Education
High School Diploma - undefined
Bonanza High
Las Vegas, NV2007
Skills
- Bilingual: native Spanish speaker (reading, writing and speaking fluently) Payroll, product merchandising, new hire training, compliance training Data entry and maintenance, information security, bank deposits, file management Liability and damage assessment, policy knowledge, conflict resolution, documentation research Call documentation, administrative and office support Up selling products and services Responding to difficult and complex customer issues/feedback, escalations Technical knowledge, medical and auto claims investigation and processing, heavy caseload management Experience with:
- Outlook, Microsoft, Teams, Windows, Max, Workday, Excel, OneNote, Guidewire ClaimCenter, PowerManage, Adobe, CRM and POS/Ordering platforms, Cyllenius, Salesforce, Customer 360, ISO Claims Search, Hertz and Enterprise business platforms, Arbitration Forums, Avaya, CallMedia, CCC One, NICE recording system, WGS claims system, Jira, Jira tickets, Pharmaceutical drug pricing platform, Macro claims processing system, NextGen claims processing system, Healthcare management platform, FileNet, Citrix, PMIS system, Facebook and Instagram content management WPM typed: 50
Languages
Spanish
Native or Bilingual
Timeline
Remote Special Projects Claims Lead Adjuster
Elevance Health
06.2023 - 08.2024
Remote Bilingual Claims Adjuster
CSAA Insurance Group
02.2022 - 08.2022
Tutor
Self Employed
08.2018 - 05.2021
Bilingual Commercial Auto Claims Adjuster
TEN Group
08.2016 - 08.2018
Assistant Sales Floor Manager
Kalifano Gemstones
03.2011 - 08.2015
Front Desk
A Better Way Insurance Agency
04.2009 - 06.2010
High School Diploma - undefined
Bonanza High