Summary
Overview
Work History
Education
Skills
Timeline
Generic

Kristal Cruz

Plainfield,Illinois

Summary

I am a driven professional with extensive experience at Travelers Insurance. I 'm excelling in claims investigation and customer service. Proven ability to enhance claim processing efficiency and foster strong relationships through active listening and critical thinking.

I'm also an organized and detail-oriented Investigator dedicated to improving efficiency, productivity and profitability through continuous process improvement.

Overview

11
11
years of professional experience

Work History

First Party Medical Payment Adjuster

Travelers Insurance
03.2024 - Current
  • Maintained strong relationships with policyholders, agents, and colleagues by consistently demonstrating professionalism, empathy, and effective communication skills.
  • Ensured compliance with state regulations and company policies through diligent review of all claim-related materials.
  • Assisted insureds in understanding their insurance coverage by explaining complex terms and conditions clearly and concisely.
  • Improved claim processing efficiency by conducting thorough investigations and promptly addressing discrepancies.
  • Making medical payment to the providers in a timely manner.
  • Understanding medical coding.
  • Request and Review medical records.
  • Examined claims forms and other records to determine insurance coverage.
  • Communicating with Providers, other carriers and attorneys.

Auto Claims Adjuster

Travelers Insurance
03.2022 - 03.2024
  • Acted as a reliable point of contact for customers throughout the claims process, addressing their concerns with empathy and professionalism.
  • Demonstrated expert knowledge of auto insurance policies and coverages, allowing for accurate assessment of damages and appropriate claim payouts.
  • Documented all findings in concise reports.
  • Enhanced customer satisfaction by efficiently managing auto claims and providing prompt resolutions.
  • Established an effective system for tracking and monitoring claims from initial report to final resolution, ensuring timely updates were provided to all relevant parties.
  • Utilized strong negotiation skills to settle disputed liability cases in a fair and reasonable manner, ultimately minimizing company exposure to financial risk.
  • Issued payouts to claimants.
  • Expedited claim settlements by maintaining open lines of communication with all parties involved, fostering trust, and ensuring a smooth process.
  • Examined photographs and surveillance and any other documents relating to claims.
  • Reviewed police reports, photographs and other documentation to gain complete understanding of accident.
  • Identified suspicious claims, escalating issues to supervisor for further investigation and analysis.

Customer Service Team Lead

Crate and Barrel
10.2014 - 03.2022
  • Supported representatives in navigating difficult interactions with customers, offering guidance on appropriate de-escalation techniques when needed.
  • Coached new team members on service techniques and provided scoring through quality assurance program.
  • Addressed escalated customer concerns promptly, ensuring satisfactory resolutions while preserving long-term relationships.
  • Led regular team meetings to review performance data, discuss best practices, and collaborate on continuous improvement initiatives.
  • Streamlined processes for faster issue resolution, resulting in increased customer loyalty.
  • Escalated issues to proper supervisors when standard processes were not effective.
  • Managed high-performing customer service team, consistently exceeding company performance benchmarks.
  • Evaluated representative performance regularly, offering constructive feedback and implementing targeted improvement plans as necessary.
  • Took cash and credit card payments via phone and through email.
  • Served as a resource for representatives, answering questions and providing guidance on best practices in addressing specific customer concerns.
  • Improved customer satisfaction by addressing and resolving complex issues in a timely manner.
  • Checked status of orders and back-ordered products to coordinate efficient shipments.
  • Reduced average handle time through effective communication training and improved knowledge of products/services offered.

Education

Business Administration And Management

Robert Morris University
Aurora IL
06-2011

Skills

  • Claims investigation
  • Damage assessment
  • Policy interpretation
  • Property valuation
  • Critical thinking
  • Active listening
  • Decision-making
  • Claims processing
  • Casualty and property loss
  • Healthcare common procedures coding system (HCPCS)
  • Medical coding
  • Customer service
  • Problem-solving
  • Attention to detail
  • Multitasking and organization

Timeline

First Party Medical Payment Adjuster

Travelers Insurance
03.2024 - Current

Auto Claims Adjuster

Travelers Insurance
03.2022 - 03.2024

Customer Service Team Lead

Crate and Barrel
10.2014 - 03.2022

Business Administration And Management

Robert Morris University

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Kristal Cruz