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
Downers Grove, IL
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
Naperville, IL
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
Naperville, IL
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 IL06-2011
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