Katherine Jaquez Salcedo
Lakeland,FL
Summary
Senior Claims Professional with extensive experience evaluating and processing intricate insurance claims. Adept at risk assessment, policy interpretation, and ensuring adherence to industry standards. Emphasizes team collaboration and achieving optimal results. Easily adapts to changing business requirements. Recognized for reliability, analytical prowess, and effective communication skills. Proficient in third-party administration, focusing on streamlining administrative processes and compliance. Utilizes strong organizational skills to efficiently manage complex workflows. Proven track record of improving team collaboration and delivering successful outcomes.
Overview
16
16
years of professional experience
Work History
Senior Claims Examiner
CRAWFORD AND COMPANY
11.2024 - Current
- Managed complex claims to ensure timely processing and proper handling, reducing overall claim costs.
- Negotiated settlements on behalf of clients in cases of disputed claims or other disputes related to benefits administration.
- Handled escalated customer issues with professionalism and sensitivity, resolving concerns promptly and effectively.
- Analyzed performance metrics to identify areas for improvement, implementing strategic initiatives that led to better outcomes.
- Developed and implemented comprehensive training programs for new hires, resulting in increased productivity levels.
- Continuously evaluated third-party administrator processes and procedures, recommending improvements that led to increased efficiency and cost savings for clients.
- Coordinated with internal departments such as legal and finance to ensure accurate and timely processing of claims-related payments and reimbursements.
- Maintained detailed records of all third-party transactions, enabling accurate reporting and analysis.
- Served as a key liaison between clients and vendors, facilitating effective communication channels for seamless service provision.
- Reduced errors in benefits processing through meticulous attention to detail and thorough documentation review.
- Mentored junior team members on best practices in TPA administration, contributing positively to their professional growth and development.
- Ensured compliance with state regulations and internal guidelines while managing claim files from inception through closure.
- Negotiated favorable settlements for insured parties through skilled mediation and conflict resolution tactics.
- Managed a diverse caseload of complex commercial claims, resulting in timely settlements and satisfied clients.
- Contributed to team meetings and training sessions by sharing best practices, lessons learned, or case studies relevant to the commercial claims adjusting process.
- Collaborated with experts such as engineers, accountants, and medical professionals to ensure accurate claim evaluations.
- Analyzed complex coverage issues to determine appropriate course of action for each individual case.
- Examined claims forms and other records to determine insurance coverage.
- Mitigated financial losses by accurately determining liability and settlement amounts based on relevant factors such as damages, policy limits, and jurisdictional requirements.
- Worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial.
Bodily Injury and Liability Claims Examiner
GEICO
01.2019 - 10.2024
- Collaborated cross-functionally with multiple departments to address any issues or discrepancies found during investigations.
- Maintained contact with claimants and attorneys to determine treatment status.
- Managed complex litigation cases, coordinating with attorneys to present a strong defense on behalf of the insurer.
- Achieved cost savings through skillful negotiation tactics during settlement discussions with opposing counsel or claimants directly.
- Communicated effectively with all stakeholders, including insureds, claimants, attorneys, and internal departments.
- Enhanced customer satisfaction by delivering prompt and accurate claim resolutions.
- Evaluated damages accurately to determine appropriate compensation amounts within policy limits.
- Ensured compliance with state regulations and industry standards through diligent monitoring of claim activities.
- Maintained detailed records of all communications related to each claim file for easy reference when needed.
- Collaborated with legal teams to defend against lawsuits and ensure optimal outcomes for the organization.
- Identified potential fraud indicators through careful analysis of documentation and investigation findings.
- Investigated claims thoroughly, collecting relevant evidence and interviewing involved parties.
- Negotiated fair settlements with claimants, maintaining professional relationships while protecting company interests.
- Researched claims and incident information to deliver solutions and resolve problems.
- Consulted police and hospital records when needed.
- Interviewed claimants and witnesses to gather factual information.
- Examined photographs and statements.
- Worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial.
Financial Customer Service Representative
T-Mobile
03.2016 - 05.2017
- Provided excellent customer service, resolving issues quickly and maintaining long-term client relationships.
- Maintained up-to-date knowledge of industry regulations, trends, and best practices to provide informed advice to clients.
- Enhanced customer relationships with personalized service and addressing individual concerns promptly.
- Collaborated with team members to achieve sales targets and improve overall branch performance.
- Worked closely with other departments to provide seamless service delivery for complex client requests.
- Worked with clients to develop financial planning strategies and solutions through evaluation of finances.
- Assisted clients in navigating complex financial situations, offering solutions that met their unique needs.
- Developed rapport with customers, fostering loyalty and repeat business.
- Discussed financial options with clients and provided informed suggestions.
Security Site Supervisor
Universal Protection Services
01.2010 - 08.2015
- Oversaw team of security officers and managed scheduling and performance evaluations.
- Recorded incident reports with detailed accounts of occurrences.
- Removed unauthorized persons from facility grounds.
- Managed and trained a team of security personnel for optimal performance in maintaining site safety.
- Ensured compliance with all relevant occupational health and safety regulations by regularly reviewing policies and procedures.
- Maintained detailed logs of daily activities, providing accurate records for management review.
- Monitored alarm systems, responding promptly to alerts and coordinating appropriate action.
- Participated in ongoing professional development opportunities to stay current with industry best practices.
- Coordinated fire drills for staff members, enhancing their understanding of evacuation procedures during emergencies.
- Resolved conflicts among employees or visitors professionally, promoting a safe and harmonious environment.
- Reduced incidents of trespassing by maintaining a strong security presence and enforcing access control measures.
- Implemented access badge system, improving tracking of personnel movement within the facility.
- Collaborated with local law enforcement agencies to bolster site protection and share intelligence on potential threats.
- Assisted human resources with background checks on potential hires to maintain a secure workforce.
- Completed shift handover reports and debriefed next shift upon arrival.
- Performed security investigations and reported findings to client management.
- Provided first-line support to shift workers during incidents and escalated situations as appropriate.
Education
Florida Adjuster License -
6-20
01-2019
High School Diploma -
Bowers/Whitley
Tampa, FL05-2008
Skills
- Liability analysis and determination
- Claims investigation, processing and management
- Policy interpretation and investigation
- Legal knowledge
- Computer Skills
- Critical Evaluation
- Litigation management and support
- Negotiation and mediation
- Customer service and support
- Multitasking
- Coaching and mentoring
Languages
Spanish - Native or Bilingual
Timeline
Senior Claims Examiner
CRAWFORD AND COMPANY
11.2024 - Current
Bodily Injury and Liability Claims Examiner
GEICO
01.2019 - 10.2024
Financial Customer Service Representative
T-Mobile
03.2016 - 05.2017
Security Site Supervisor
Universal Protection Services
01.2010 - 08.2015
Florida Adjuster License -
6-20
High School Diploma -
Bowers/Whitley
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