Jonathan Guerrero
Conroe,TX
Summary
Ambitious, personable, and highly organized professional with excellent written/verbal communication skills seeking an opportunity in a supervisor role where I can maximize resilient work ethic, claim adjuster experience, and excellent claim handling skills. Experienced with complex claims evaluation and resolution, focusing on accuracy and compliance. Utilizes analytical skills and policy knowledge to enhance claim processing. Track record of effective communication and teamwork in high-pressure situations.
Overview
21
21
years of professional experience
Work History
Senior Claims Examiner
California Fair Plan
07.2021 - Current
- Contributed to company growth by consistently meeting or exceeding productivity targets without sacrificing quality standards.
- Maintained up-to-date knowledge of industry trends and legislative changes, ensuring accurate claim evaluations.
- Collaborate with Claims Management and legal counsel on claims involving litigation, ensuring all legal aspects are thoroughly addressed and documented.
- Promptly negotiate settlements, ensuring that the agreed amounts reflect actual insured losses while protecting the company from invalid claims.
- Investigate, evaluate, and resolve complex property claims, leveraging technical knowledge and interpersonal skills to promote fair, accurate, and prompt settlements.
- Adjust reserves as necessary and provide reserve recommendations to ensure all reserving activities are in line with company policies and financial objectives.
- Document claim transactions clearly and concisely, maintaining thorough and accurate records to ensure compliance and efficiency.
- Review claims inspected by independent adjusters, conducting further investigation into questionable claims, verifying coverage, and ensuring timely payments to policyholders.
- Conduct daily diary reviews on active claim files, ensuring timely issuance of status letters in compliance with Department of Insurance regulations.
- Approve and process claims within designated authority levels, ensuring all payments align with policy terms and company guidelines.
- Assist independent adjusters, ensuring their adherence to CFP IA guidelines, company standards, and regulatory requirements.
- Reduced claim resolution time by conducting thorough investigations and timely decision making.
- Followed up with insured individuals regarding premium and deductibles payments.
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Ensure full compliance with Department of Insurance regulations, company policies, and internal procedures in all aspects of claims handling.
- Draft and review correspondence to policyholders, ensuring accuracy, completeness, and adherence to regulatory standards.
Property Claims Adjuster
Allstate Insurance Company
01.2017 - Current
- Speak to customers via phone/face-to-face video, investigate, and determine coverage of loss, and adjusts all elements of routine property loss claims, homeowner, earthquake, and boat claims
- Explain coverage of loss, assists policyholders with itemization of damages, emergency repairs and additional living arrangements
- Experience as an ALE, Good Hands Repair Network, Xactanalysis, and Xactimate certified
- Request refunds from contractors, log refunds and follow up until received, if customer is having complaints with vendor I follow up with the vendor to make sure concerns are resolved, Log and assign estimates to correct department if need, follow up with contractors for status of claim and completion of repairs
- Determines appropriate settlement amount based on independent sound judgment, estimation of actual cash value and/or replacement value, and validating contractor estimates
Specialty Coordinator
U.S HealthWorks Medical Group
01.2007 - 01.2017
- Confirm eligibility of patients regarding health insurance
- Coordinate and ensure department referrals are carried out in a timely manner
- Coordinate and train front desk personnel on insurance provider follow up and patient claims
- Assist and ensure department maintains referrals current and updated
- Create, update and monitor inventory management systems, files, databases
- Obtain, verify and maintain various information, reports, files and lists
- Discharge patients and arrange referral follow-up appointments
- Assists in department communications including information gathering and coordinating/scheduling of distribution
- Provide excellent customer service to clients, insurance providers and employers
Store Operations Lead
Disneyland Resort
01.2004 - 01.2007
- Supervise and direct staff effectively
- Ensure all employees are working in a safe and healthy environment
- Ensure compliance with inventory and regulatory protocols are met
- Create, update and monitor inventory management systems, databases
- Assist in department communications including information gathering and coordinating/scheduling of distribution
- Provide excellent customer service to guests and cast members
Education
Bachelor of Science - Business Administration
University of Phoenix
Online01.2015
High School Diploma -
El Rancho High School
Pico Rivera, CA01.2003
Skills
- Proficient in Spanish
- Attention to Detail
- Decision making
- Priority setting
- Task management
- Adaptability
- Self-starter
- Organizational skills
- Time management
- Office Management
- Claims analysis
- Investigation techniques
- Policy Interpretation
- Litigation Management
- Claim Resolution
- Verbal Communication
Languages
Spanish
Native or Bilingual
Timeline
Senior Claims Examiner
California Fair Plan
07.2021 - Current
Property Claims Adjuster
Allstate Insurance Company
01.2017 - Current
Specialty Coordinator
U.S HealthWorks Medical Group
01.2007 - 01.2017
Store Operations Lead
Disneyland Resort
01.2004 - 01.2007
High School Diploma -
El Rancho High School
Bachelor of Science - Business Administration
University of Phoenix