Karla Nay
Orlando,FL
Summary
Experienced Licensed Claims Adjuster in Florida with a strong background in the insurance industry and a proven track record of providing exceptional customer service for over 8 years. Committed to ensuring customer satisfaction and making valuable contributions to company success. Thrives in fast-paced, deadline-driven environments and approaches tasks with energy and enthusiasm. Known for meticulous attention to detail, dependability, flexibility, and exceptional multitasking abilities.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Senior Claims Examiner
One80 Intermediaries Inc.
06.2023 - Current
- Responsible for all aspects of the claims process.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Performs audit reviews and adjudication of complex high dollar claims by completing an end-to-end audit with final approval authority.
- Identify suspicious losses and recommended referrals to assist with investigations and claim settlement.
- Document all investigation activity in the claim.
- Assist in training of new or junior associates.
Claims Examiner
One80 Intermediaries Inc.
04.2022 - 06.2023
- Independently process travel claims in accordance with associated policies.
- Review assigned claims, contact the insured and other affected parties, set expectations for the remainder of the claim, and initiate documentation in the claim handling system.
- Confirms coverage of claims by reviewing policies and documents submitted in support of claims.
- Evaluate, Negotiate, and settle claim when appropriate.
- Handle incoming calls from and makes outgoing calls to claimants and suppliers in a professional, positive, and proactive manner.
- Consistently meet established performance standards, including quantity and quality claims processing standards.
- Maintain current knowledge of Plan(s) and effectively applies this knowledge to the payment of claims, customer service, and all other job functions.
- Ensure that CBP maintains HIPAA compliance in all areas.
Customer Care Assistant Manager
North America Risk Services
09.2019 - 11.2021
- Responded to customer needs through competent customer service and prompt problem-solving.
- Review daily reports created by Customer Communications Manager (CCM) to determine areas for improvement as well as high achievers.
- Review areas for improvement with the team and set expectations for improvements.
- Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
- Conduct Claim setup and call audits on claims Intake Team.
- Oversee triaging of work orders and distribution.
- Assist prioritizing and follow-up on new claims requests.
- Make sure that all claims are assigned correctly and set up in a timely manner.
- Work with Customer Communications Manager to create reports, procedures and monitor call volumes throughout the day to make sure staffing requirements are met.
- Train CSRs on claim handling questions, customer service advice and client procedures.
- Handle escalated calls from the team.
- Assist in the distribution of escalated calls to appropriate adjusters, teams, directors.
- Conduct Monthly Team meetings and bi-monthly Individual meetings with each CSR to review performance, audit results and any questions the CSR may have.
- Responsible for the research and routing of unidentified (HOLD) claims.
- Work with Account Management and Clients to identify and properly route unidentified claims.
- Conduct claim and call investigations for Quality Assurance and Clients when a complaint or issue arises.
- Report to QA, Director and Clients on investigation results and provide Action Plans.
- Make sure specific client guidelines are being adhered to by the team.
- Correct data and provide notification to Account Management and/or Quality Assurance.
- Assist in designing new team procedures based on client requirements, train on those procedures and enforce compliance.
- Create and distribute client updates, new program notifications and special handling guidelines on all programs.
Adjuster
North America Risk Services
05.2019 - 09.2019
- Review the losses (Property, auto and general liability claims, workers compensation).
- Analyzed information gathered by investigations to report findings and recommendations.
- Promptly and effectively handle to conclusion all assigned claims with little to no direction and oversight.
- Open, close and adjust reserves in accordance with company practices designed to ensure reserve adequacy.
- Ensure that the client is kept informed, receives a clear explanation and is shown care and concern throughout the claim process.
- Investigated, processed, and settled first/third party claims for total losses involving automobiles and properties.
- Maintain quality control/satisfaction records, constantly seeking new ways to improve customer service.
- Obtained all necessary information to complete proper evaluation of injury claims.
- Reviewed data to verify the validity of claims.
- Drafted a statement of loss to summarize damages, payments and underlying policy coverage.
- Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
Senior CSR (Claims intake)
North America Risk Services
12.2017 - 05.2019
- Triage new losses (auto, general liability, worker compensation and property claims).
- Assists management with new team member training.
- Delegate tasks and set project deadlines.
- Managing large amounts of inbound and outbound calls in a timely manner.
- Provides quality customer service, including interacting with customers, answering customer enquiries, and effectively handling customer complaints.
- Enter and maintain required claim information into the company claim system.
- Review invoices and requisitions for satisfactory payment approval.
- Check vendor files for any previous payments and assign voucher numbers.
- Obtain proper information and/or data regarding invoice payments.
Customer service agent (call center)
Encore global Solutions
08.2017 - 11.2017
- Managing large amounts of inbound and outbound calls in a timely manner.
- Following call center 'scripts' when handling different topics.
- Identifying customers' needs, clarifying information, research every issue and providing solutions.
- Communicated with clients regarding account services, statements, and balances.
- Demonstrated high attention to detail, organization and management of multiple tasks and projects simultaneously.
- Updated account information to maintain customer records.
Supply Specialist (92Y)
USA Army Reserve
08.2008 - 11.2017
- Receives, inspects, inventories, loads, unloads, segregates, stores, issues, delivers and turns-in organization and installation supplies and equipment.
- Receive, open, sort, and distribute both incoming and outgoing mail; route mail to various points within and outside the organization.
- Synchronized supply chains to optimize inventory and service procedures.
- Reviewed supply policies, plans and procedures to resolve issues impacting logistics operations and supply accountability.
- Prepares all unit/organizational supply documents.
- Maintains automated supply system for accounting of organizational and installation supplies and equipment.
- Issues and receives small arms.
- Secures and controls weapons and ammunition in security areas.
- Schedules and performs preventive and organizational maintenance on weapons.
- Inspects completed work for accuracy and compliance with established procedures
- Coordinates supply activities.
- Reviews and annotates changes to unit material condition status report.
- Post transactions to organizational and installation property books and supporting transaction files.
- Determines method of obtaining relief from responsibility for lost, damaged and destroyed supply items.
Education
Bachelor's Degree - Cellular and Molecular Biology
UMET
05.2011
Skills
- Fluent in English and Spanish
- Proficient with MS Word, Excel, and PowerPoint
- Multitasking Abilities
- Critical Thinking aptitude
- Time management
- Negotiation/ settlement
- Excellent Organizational, Verbal & Interpersonal Skills
- Policy Interpretation
- Investigation techniques
- Claims analysis
Certification
6-20 All lines adjuster license (Florida)
Timeline
Senior Claims Examiner
One80 Intermediaries Inc.
06.2023 - Current
Claims Examiner
One80 Intermediaries Inc.
04.2022 - 06.2023
Customer Care Assistant Manager
North America Risk Services
09.2019 - 11.2021
Adjuster
North America Risk Services
05.2019 - 09.2019
Senior CSR (Claims intake)
North America Risk Services
12.2017 - 05.2019
Customer service agent (call center)
Encore global Solutions
08.2017 - 11.2017
Supply Specialist (92Y)
USA Army Reserve
08.2008 - 11.2017
Bachelor's Degree - Cellular and Molecular Biology
UMET
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