Maria Eugenia Heredia
Mission Viejo,CA
Summary
Detail-oriented professional with extensive experience in bodily injury claims management. Expertise in decision-making, litigation management, and insurance regulations has led to effective resolution strategies and improved negotiation outcomes.
Overview
36
36
years of professional experience
Work History
Bodily Injury Claims Specialist
Automobile Club of Southern California
Costa Mesa, CA
01.2022 - 08.2024
- Evaluated and processed bodily injury claims to ensure compliance with policy guidelines.
- Collaborated with medical professionals to assess treatment costs and validate claims accuracy.
- Communicated effectively with claimants, providing updates and resolving inquiries promptly.
- Analyzed claim documentation to identify discrepancies and implement resolution strategies.
- Coordinated with legal teams to manage complex cases requiring litigation support and negotiation.
- Improved negotiation outcomes for settlements with meticulous documentation and clear communication.
- Utilized strong analytical skills to identify potential subrogation opportunities, reducing company payout expenses.
- Educated policyholders about their coverage benefits, helping them understand how their policies applied to specific situations.
- Developed strong relationships with claimants, ensuring empathetic communication while maintaining professionalism.
- Reduced company exposure to potential lawsuits by identifying potential fraud and adhering to legal guidelines during claim handling.
- Maintained detailed records of each claim, streamlining the process for future reference and audits.
- Participated in team meetings and contributed valuable insights that led to improvements in overall claim handling strategies.
- Collaborated with medical professionals, attorneys, and other experts to gather evidence and validate claims accurately.
- Attended mediations or arbitration hearings when necessary, representing the company''s interests professionally and effectively.
Bodily Injury Claims Specialist
State Farm Insurance Inc
Bloomington, IL
01.1989 - 08.2019
- Developed comprehensive reports detailing claim status and recommendations for case progression.
- Streamlined claims processing workflows, enhancing efficiency and reducing turnaround times.
- Mentored junior staff on best practices in claims management and customer service excellence.
- Managed a high volume of cases efficiently, prioritizing tasks based on urgency and complexity.
- Provided guidance to junior staff members on complex case scenarios involving multiple parties or liability disputes.
- Delivered exceptional customer service through consistent communication regarding updates on the status of their claims.
- Ensured compliance with state regulations during every stage of the claims process, minimizing risk for both the company and policyholders.
- Achieved successful claim resolutions by thoroughly investigating and evaluating bodily injury claims.
- Conducted timely negotiations with claimants'' representatives to reach fair settlements within policy limits.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Evaluated and settled complex insurance claims in strict timeframes.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Collaborated with medical professionals, attorneys, and other experts to gather evidence and validate claims accurately.
- Attended mediations or arbitration hearings when necessary, representing the company''s interests professionally and effectively.
- Participated in team meetings and contributed valuable insights that led to improvements in overall claim handling strategies.
Education
Bachelor of Science - Business Management
Azusa Pacific University
Azusa, CA05-1999
Skills
- Medical records analysis
- Claims investigation
- Settlement negotiation
- Liability assessment
- Litigation management
- Insurance regulations
- Injury evaluation
- Claims analysis
- Decision-making
Languages
Spanish
Native or Bilingual
Timeline
Bodily Injury Claims Specialist
Automobile Club of Southern California
01.2022 - 08.2024
Bodily Injury Claims Specialist
State Farm Insurance Inc
01.1989 - 08.2019
Bachelor of Science - Business Management
Azusa Pacific University