Jose Reyes
Roxbury,MA
Summary
Results-oriented individual with a passion for continuous learning and innovation. Known for leveraging analytical thinking and creativity to solve problems and deliver high-impact solutions in fast-paced environments.
Overview
9
9
years of professional experience
Work History
Workers Comp Claims Adjuster - National Accounts
Travelers
West Bridgewater, MA
06.2019 - Current
- Conferred with all parties whilst conducting investigations to gather information and educate on claim processes, benefits, requirements and state guidelines.
- Monitored claim progress while developing plan for resolution.
- Coordinated with medical professionals to arrange treatment, discuss co-morbidities and progress expectations for injured claimants while providing relevant information to medical offices regarding work duties.
- Calculated amounts owed to claimants and issued compensation within state jurisidication guidelines.
- Consulted defense counsel to identify claims at risk of litigation and plan defense strategy for claims in active litigation.
- Applied personal judgment in evaluating legal status of claims and interacting with insured to inform of risk and exposure.
- Determined liability, compensability and benefits due on each claim.
- Reviewed compensation program and developed strategic short- and long-term plans to increase efficiency and mitigate claim cost.
- Analyzed information gathered by investigations, identified suspicious claims and reported findings to appropriate parties, while taking appropriate action for resolution.
- Utilize company resources for investigative and resolution purposes.
- Deliver exceptional customer service to clients communicating information and actively listening to concerns.
- Gathered and documented evidence to support court proceedings.
- Timely filing of all forms per state guidelines
- Efficiently and cost effectively evaluating exposure on claims and negotiating settlements and benefits due while maintaining integrity.
- Developed strategies to resolve complex cases within established timeframes.
Customer Service Representative II
AAA
Providence, Rhode Island
01.2018 - 06.2019
- Answered all incoming calls in a personable and professional manner
- Responded promptly to general inquiries from potential members, staff and clients via mail, e-mail and fax.
- Resolved issues quickly through meticulous research and quick decision making.
- Reduced financial discrepancies by accurately resolving billing issues while processing applications, corrections, endorsements and cancellations.
- Created reports and other types of documentation, which often contained sensitive and confidential data.
Education
Some College (No Degree) -
Baystate College
Boston, MA, USSkills
- Multi-tasking and organization
- Time Management
- MS Office proficiency
- Teamwork and collaboration
- Leadership
- Conflict resolution skills
- Communication Skills
- Detail oriented
Accomplishments
- Lead Member of Fee Agreement Team
- Created and coordinates monthly strategic resolution roundtable
- Summer Intern Onboarding
- Medical Fraud Team
Licenses
- Massachusetts
- New Hampshire
- Vermont
- Rhode Island
- Connecticut
- Maine
Timeline
Workers Comp Claims Adjuster - National Accounts
Travelers
06.2019 - Current
Customer Service Representative II
AAA
01.2018 - 06.2019
Some College (No Degree) -
Baystate College