Kristi Canales
Cibolo,TX
Summary
Results-driven professional with strong technical skills and a commitment to enhancing customer satisfaction. Proven ability to manage multiple tasks efficiently while maintaining high service standards. Dedicated to creating positive experiences for customers through effective communication and problem-solving.
Overview
18
18
years of professional experience
Work History
Foster parent
Bair Foundation Foster Agency
10.2017 - 10.2021
- Logs, Dr Appointments, school meeting, ISP, organizing and keeping daily logs of children’s behavior, planning monthly calendar, therapy sessions, caring for children and loving them as own.
Medical Record Associate
Goodwill Industries of
02.2018 - 12.2020
- Ensure all records and loose flowing documents received are accurately entered into tracking database within prescribed timelines.
- Conduct thorough research and ensure all records received on Active service members are forwarded to appropriate location as well as document all actions taken to retrieve missing components or records.
- Properly prepare records for scanning by removing staples; making copies of documents that cannot be scanned as well as remove erroneously filed documents on other personnel filed in service member’s records.
- Meet quota objective for each phase of record transition.
- Data entry, verification, research, document preparation, scanning, quality control, disposition, and destruction.) Perform quality control of all documents scanned prior to uploading documents into document repository; and records are uploaded into correct record.
- Properly fill out certification form and upload completed records, computer generated record and certification form into document repository within prescribed timelines.
- Ensure tracking database is updated accurately at each phase as record transitions through process.
- Communicate effectively both orally and in writing.
- Proficient with basic level computer skills, MS Office Suite, data entry and computer operation Ensure proper disposition of all scanned records and document destruction.
- Manage inventory of records accurately; retrieve requested records within timelines required.
- Provide excellent customer service by greeting, assisting, and responding to questions and/or concerns in positive, professional, and friendly manner.
SWBC, Mortgage Claims
Lenders Placed Operation Claims Rep
05.2015 - 10.2018
- Take claims over phone and provide claim information.
- Reviewed Adjuster’s reports making payments when needed.
- Provided written and verbal customer service on mortgage insurance claims.
- Received and monitored claim filings via Focus Net, including inputting initial claims, assigning adjuster/carrier as appropriate and updating changes to policies/coverage information.
- Review status of closed Claims for issuing letters, checks, and reserve extensions
- Process Claim Reports such as End-of-Month Reports, Loss Ratio Reports, and other special queries.
- Advised Insurance carrier of "above authority” losses, liability claims and lawsuits.
- Assisted Data Processing Department in system enhancements and trouble shooting.
Insurance Agent Assistant
SWBC
06.2013 - 05.2015
- Interacted with vendors, contractors and professional services personnel to receive orders, direct activities, and communicate instructions.
- Surpassed team goals by partnering with colleagues to implement best practices and protocols.
- Managed phone and email correspondence and handled incoming and outgoing mail and faxes.
- Managed filing system, entered data and completed other clerical tasks.
- Performed research to collect and record industry data.
Insurance Agent Associate
Jacob & Weber
Yoakum, Texas
10.2011 - 10.2013
- Conducted client meetings to discuss policy limit adjustments and financial status changes.
- Managed appointment scheduling and investigated insurance claims for various losses.
- Maintained accurate records and prepared necessary reports for client assistance.
- Facilitated claims filing and settlement processes for clients seeking support.
- Analyzed claims data to determine potential areas of improvement for policyholders' protection.
- Provided customers with information regarding plan features, pricing, and availability.
- Educated customers on the importance of maintaining adequate insurance coverage.
- Generated reports detailing sales activities, client interactions, and progress towards goals.
- Developed relationships with new clients through cold calling and referrals from existing customers.
- Conducted research to identify competitive rates and benefits offered by other providers.
- Negotiated contracts between insurers and insured parties in order to obtain favorable terms for both sides.
- Ensured compliance with applicable laws, regulations, and company policies while selling insurance products.
- Prepared documents such as applications, endorsements, renewals, cancellations, or other forms required by law or company procedures.
Specialist
Lackland AFB DOD- Benefits
12.2008 - 07.2010
- Made calls both manually and via dialer technology to Credit Union members who were interested in insurance quotes and transferred them to SWBC Agents to be further assisted
- Documented calling efforts in programs such as EZLynx and Akcelerant to provide feedback, including completion of SLO’s and establishing call back schedules
- Educated Credit Union members on the benefits of purchasing insurance in partnership with SWBC
- Provided internal and external Customer Service Support to enhance relationship management and daily interaction with financial institutions
- Handled complex questions and problems through managing Support line and updating Auto Pilot product information., Recovery 3rd Party Collections, LACKLAND AFB
- Knowledge of EOBs, UB92, HCFA 1500 and ICD-9 forms and HIPPA
- Knowledge of Citrix Arms and Tpocs
- Claims processing, appeals letters, and correspondence to insurance companies when health insurance claim is denied
- Handled check research, pulled checks, issued checks accounts payable for time loss, waiting on receipt of checks, follow up and resolution of accounts, rebill claims
- Ability to analyze, research and problem solve
- Attention to detail in organizing and planning, ability to effectively manage time an achieve results
- Able to work in a team environment in a positive professional manner.
RANDOLPH AFB
DOD - Work Comp Insurance Claims Adjuster
03.2008 - 12.2008
- Receive claim assignment, confirms policy coverage, and directs acknowledgement of claims
- Interpret and make decisions using independent judgment on moderate-to-difficult claims and policy coverage and determines if coverage applies to claims submitted
- Investigate claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required
- Analyze claims activity and prepares reports for clients/carriers and management
- Establish reserves, using independent judgment and expertise and authorizes payments in accounts payable, within scope of authority, settling claims in the most cost-effective manner and ensuring timely issuance of disbursements
- Settle claims promptly and equitably and issues company drafts in payments for claims within authority limits
- Develop subrogation and third-party recovery potential and follows reclaim procedures
- Analyze claims activities and prepare reports for clients, carriers and/or management
- Participate in claim reviews.
receptionist, mail room clerk
Injury Insurance Claims Adjuster
07.2003 - 03.2008
- Providence Risk insurance Services
- Started, , account receivable and accounts payable, claim assistant to adjuster; claims trainer/ supervised 8 trainees-and became a multi- line licensed insurance adjuster
- I wore many hats in a short time within the company
- Managed opening/ closing front to office, PBX phone system, scanning, faxing, Scheduling meetings/ appointment, greeting clients, processed incoming outgoing mail, handled accounts payable, trained new hire claims assistants of the required job duties as need per adjuster requirements
- Claims adjuster investigates and evaluates insurance claims submitted by insurance policy holders
- Claims adjuster handled correspondence with claimants and witnesses, research, reporting and settling claims
- Estimate damages and repair costs, interviewing claimants, witnesses and professionals involved in settlement of the claim, perform additional research, and reviewed all related documentation.
Education
Computer Office Business Technology, Certification Course Work: Bookkeeping, Basic Accounting, Business Math/Writing Medical Terminology Licensed Notary Public, Texas All Lines Licensed Insurance Claims Adjuster, Texas ICD-10 Training and Surveillance Alternatives I & II -
Texas Careers Technical School
San Antonio, Texas2003
Some College (No Degree) - Paraprofessional
Region 20
San Antonio, TXInsurance Agent Course -
Kaplan College
San Antonio, TexasProperty, Casualty and Surety, License -
San Antonio Community College
San Antonio, TexasLicense - Work Injury
Providence Risk Insurance
TexasBasic Insurance Course, Certification -
San Antonio Community College
San Antonio, TexasSkills
- Microsoft Office Suite
- Data entry and management
- Records preparation and processing
- Payment posting and reconciliation
- Interpersonal communication skills
- Confidentiality maintenance
- Departmental collaboration
- Process efficiency improvements
- Customer service
- Claims processing
- Data entry
- Document preparation
- Attention to detail
- Time management
- Effective communication
- Professionalism and ethics
- Organizational skills
- Customer follow-up
- Claims information gathering
Languages
English
Professional
Timeline
Medical Record Associate
Goodwill Industries of
02.2018 - 12.2020
Foster parent
Bair Foundation Foster Agency
10.2017 - 10.2021
SWBC, Mortgage Claims
Lenders Placed Operation Claims Rep
05.2015 - 10.2018
Insurance Agent Assistant
SWBC
06.2013 - 05.2015
Insurance Agent Associate
Jacob & Weber
10.2011 - 10.2013
Specialist
Lackland AFB DOD- Benefits
12.2008 - 07.2010
RANDOLPH AFB
DOD - Work Comp Insurance Claims Adjuster
03.2008 - 12.2008
receptionist, mail room clerk
Injury Insurance Claims Adjuster
07.2003 - 03.2008
Computer Office Business Technology, Certification Course Work: Bookkeeping, Basic Accounting, Business Math/Writing Medical Terminology Licensed Notary Public, Texas All Lines Licensed Insurance Claims Adjuster, Texas ICD-10 Training and Surveillance Alternatives I & II -
Texas Careers Technical School
Some College (No Degree) - Paraprofessional
Region 20
Insurance Agent Course -
Kaplan College
Property, Casualty and Surety, License -
San Antonio Community College
License - Work Injury
Providence Risk Insurance
Basic Insurance Course, Certification -
San Antonio Community College
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