Jorge Orellana
Frankfort,IN
Summary
Results-driven claims management professional with multiple licenses and bilingual speaker prepared for this role with strong background in assessing and processing claims, resolving disputes, and ensuring compliance with regulations. Skilled in risk analysis, negotiation, and policy interpretation, with proven track record of fostering team collaboration and adapting to changing needs. Known for reliability, effective communication, and focus on achieving optimal outcomes.
Overview
16
16
years of professional experience
Work History
Claim Manager
Primacy Risk Services
11.2021 - Current
- Enhanced customer satisfaction with timely and accurate claims resolutions.
- Documented and communicated timely claims information while supporting accurate outcomes.
- Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
- Negotiated settlements with claimants, achieving fair outcomes while controlling costs.
- Conducted thorough investigations of complex claims, gathering evidence to support decision-making processes.
- Researched claims and incident information to deliver solutions and resolve problems.
- Maintained contact with claimants and attorneys to determine treatment status.
- Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Determined proper course of action for claims processing.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Organized and detail-oriented with a strong work ethic.
Senior Claims Representative
National Interstate Insurance Company
09.2019 - 11.2021
- Full time remote worker
- I handled minor to complex claims for the Specialty Division
- Which includes Ambulances, tow trucks, waste trucks, crane and rigging vehicles, Energy and Propane trucks
- I also handled General Liability and Property losses for these insured locations
- I assist in taking Spanish calls as well to speak to insured and claimant drivers
- Worked productively in fast-moving work environment to process large volumes of claims.
- Recommended and set reserves based on expected payouts.
- Provided exceptional customer service when addressing inquiries from clients regarding their claim status or policy coverage details.
- Developed strong relationships with insurance providers, promoting effective communication for claim resolution.
- Negotiated fair settlements with claimants, contributing to favorable outcomes for all parties involved.
- Collaborated with legal and medical professionals to gather necessary information for claim assessments.
Liability Claims Adjuster
Great West Casualty
06.2012 - 07.2019
- Spearheaded claims negotiations up to $500K and contributed to litigation processes for unsuccessful settlements
- Gathered and documented evidence to support court proceedings
- Verified liability extent with reviews of police reports, medical treatment histories and other records
- Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions
- Determined insurance coverage levels and restrictions by thoroughly examining claims forms and associated records
- Resolved conflicts and negotiated agreements between parties in order to reach win-win solutions to disagreements and clarify misunderstandings
- Delivered an exceptional level of service to each customer by listening to concerns and answering questions
- Protected company reputation and built loyal client base by working relentlessly to resolve problems and improve customer satisfaction
- Serious Loss field work experience Liability and Property Damage Claims
- Caseload of up to 100 Claims
- Improved overall accuracy in claims investigations by developing a comprehensive checklist for gathering essential information.
- Maintained detailed records for each claim, ensuring accuracy and completeness for future reference and audit purposes.
- Managed a caseload of complex liability claims, maintaining organization and meeting deadlines consistently.
- Collaborated with legal teams for successful case resolutions, ensuring proper documentation was submitted.
- Enhanced customer satisfaction by providing timely updates on claim status and addressing concerns promptly.
- Evaluated coverage applicability for incoming liability claims; ensuring accurate payment allocation based on policy terms.
- Resolved disputes effectively through mediation efforts between involved parties as an alternative to litigation when possible; reducing costs associated with lengthy court proceedings.
- Negotiated fair settlements with claimants, considering both their needs and the financial interests of the company.
- Investigated liability claims thoroughly, analyzing evidence and interviewing involved parties to determine fault accurately.
Claims Adjuster
The Hartford
08.2008 - 06.2012
- Worked closely with appraisers, rental facilities, body shops and salvage vendors
- Fostered relationships with customers to expand customer base and enhance loyalty and retention
- Handled 1st party Auto Damage claims
- Processed all paperwork for Total Loss vehicles
- Serviced Spanish speaking customers
- 20-40 new claims daily
- Verified insurance claims and determined fair amount for settlement.
- Achieved high customer satisfaction ratings by providing clear and timely communication throughout the claims process.
- Prepared summaries of damage, payments, and policy coverage.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Examined claims forms and other records to determine insurance coverage.
- Answered customer questions regarding deductibles.
Education
Ordination - Theology
Indiana Bible College
Indianapolis, INSkills
- Property and Casualty Insurance
- General Liability
- Auto Insurance
- Tow Truck
- Conflict Management
- Flatbed
- Tractor-Trailer
- Claims review
- Complex problem-solver
- Regulatory compliance
- Negotiation proficiency
- Reporting abilities
- Self-motivated
- Documentation skills
- Building strong relationships
- Commercial insurance
- Casualty auto insurance
- Skilled negotiator
- Organized
- Thrives under pressure
- Excellent communication skills
- Property and casualty products
- Fluent in Spanish
- Microsoft Office
- Word
- Powerpoint
- Excel
- Outlook
- Claims analysis
- Claims investigation and research
- Investigation techniques
- Claims Processing
- Liability management
- Claims
- Settlement Negotiations
Languages
Spanish
Full Professional
Timeline
Claim Manager
Primacy Risk Services
11.2021 - Current
Senior Claims Representative
National Interstate Insurance Company
09.2019 - 11.2021
Liability Claims Adjuster
Great West Casualty
06.2012 - 07.2019
Claims Adjuster
The Hartford
08.2008 - 06.2012
Ordination - Theology
Indiana Bible College