Jessica Gorrita
Miami,FL
Summary
My objective as a motivated and goal orientated individual is to obtain a position within the organization, where I can apply my strong communication analytical and interpersonal skills to professionally interact with various levels of employees, management and external contacts. Excellent verbal and communication skills, team player able to work cooperatively share relevant information with others. Able to keep confidentiality.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Claims Adjuster
Embark General
Miami, FL
06.2023 - Current
- Maintained clear communication channels with all parties involved in a claim, fostering positive relationships and trust in the process.
- Developed comprehensive knowledge of relevant laws and regulations pertaining to bodily injury insurance claims handling.
- Adhered to regulatory guidelines throughout the claims process, upholding professional standards and ethical practices at all times.
- Conducted scene investigations when necessary to gather additional evidence in support of claim decisions.
- Reduced claim processing time by effectively managing a caseload of personal injury claims.
- Identified fraudulent claims swiftly through meticulous review processes that safeguarded company resources from unnecessary expenses.
- Minimized litigation costs through effective case management and proactive settlement negotiations.
- Achieved fair resolutions through skilled negotiation tactics while maintaining sensitivity toward injured parties'' needs and concerns.
- Enhanced customer satisfaction by providing timely and accurate evaluations of liability.
Bodily Injury Adjuster
United Automobile Insurance
09.2010 - 06.2023
- Ability to independently resolve auto liability claim including interpretation of policy language, evaluation of damages and negotiation techniques
- Investigate, evaluate, negotiate and resolve non-attorney and attorney represented bodily injury claims
- Provided efficient performance in assessing and evaluating injuries and determined settlement structures
- Maintained a pending of over 250 exposures
- Take recorded statements and examinations under oath on coverage and liability issues
- Request medical records for independent reviews including related MRIs and X-rays
- Consistently obtained high closing ratios
- Knowledge in procedures and regulations for multiple states (Florida, Texas, Oklahoma, Utah, Mississippi, Arkansas, Indiana, Illinois)
- Monitor online dockets for possible filing of summons and complaints
- Prepare litigated files for defense counsel
- Maintain a current diary at all times, update status notes and establish target dates
- Identified potential suspicious claims and referred to SIU and identified opportunities for third party subrogation
- Communicate with various individuals internally and externally to include policyholders, claimants, medical providers and attorneys while providing excellent customer service
- Analyzed information gathered by investigation and report findings and recommendations
- Requested outside investigation from independent vendors as necessary
- Excellent negotiation skills and experience in dealing with legal and medical professionals.
Receptionist
Hialeah Dental
01.2010 - 10.2010
- Front desk/greeter
- Verify insurance information
- Clerical and Administrative work
- Schedule Appointments
- Maintain and update patient records
- Schedule patient procedures
- Manage phones.
Service advocate
Blue Cross Blue Shield of Florida
09.2005 - 02.2009
- Provide subject matter expertise to peers and various workgroups and projects
- Receive and respond to incoming calls on all lines of business regarding benefits, claims and eligibility
- Handle issues and provide information for transactions, inquiries, complaints and document information
- Handle various member and provider request (i.e
- Address changes, ID cards, provider participation status, authorizations and contractual issues)
- Access information from a variety of systems and references
- Resolve complicated, analytical and lengthy issues on an everyday basis
- Handle written correspondence for Senior Contract Center including PHI information, member reimbursement, web inquires and member complaints
- Participated in various Process Improvement projects.
Education
Hialeah Miami Lakes
Hialeah 06.2005
Skills
- Excellent analytical and problem-solving skills
- Excellent written and verbal communication skills
- Strong leadership, interpersonal, organizational and prioritization skills
- Knowledge of CPT, ICD-9, HCPS codes
- PC literate in Microsoft, Excel and PowerPoint
- Knowledge of Medical Terminology
- Fluent in both English and Spanish
- Ability to read, analyze and interpret insurance policies and technical procedures
- Possess analytical, problem solving and conflicting resolution skills
- Very well organized and ability to work in a fast-paced environment
- Excellent verbal and communication skills
Licenses
0620 - ADJUSTER - ALL LINES, W084374
Certification
Active 620 license
Timeline
Claims Adjuster
Embark General
06.2023 - Current
Bodily Injury Adjuster
United Automobile Insurance
09.2010 - 06.2023
Receptionist
Hialeah Dental
01.2010 - 10.2010
Service advocate
Blue Cross Blue Shield of Florida
09.2005 - 02.2009
Hialeah Miami Lakes