Martha Mena
Fort Lee
Summary
Seasoned insurance specialist with excellent planning and problem solving abilities. Offering several years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments. Skilled in handling complex insurance claims and policy processing with experience in navigating through various insurance software systems. Demonstrates strong analytical skills, adept at interpreting policies and efficiently resolving claims to the satisfaction of all parties involved. Known for maintaining high accuracy levels in document processing and data entry, contributing to streamlined operations and improved customer service outcomes. Continuously seeks ways to optimize workflows and enhance team productivity, leading to more efficient claim resolution processes.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Bilingual CLRU Claims Representative
Progressive
03.2024 - Current
- Prepare written correspondence to ensure clear communication with claimants and involved parties.
- Adhere to company conduct, ethics, and compliance policies while following state and federal regulations.
- Collaborate with adjusters, appraisers, and other professionals to facilitate timely claims resolution.
Liability Adjuster
GEICO
05.2022 - 10.2023
- Use varying methods of investigation, including taking recorded statements, consulting with law enforcement, inspecting property damage, and reviewing documents.
- Estimate cost of repair, replacement, or compensation.
- Prepares settlement letters, denial letters, reservation of Rights, and other letters as needed.
- Resolve liability and coverage condition.
- Analyzed policy language and coverage to determine liability in each claim.
- Negotiated settlements with claimants and attorneys in a timely and efficient manner.
- Developed and maintained relationships with clients, attorneys, and other third parties.
- Utilized investigations to determine facts in each claim and recommend appropriate settlement amounts.
- Educated clients on insurance policies and best practices for risk management.
Authorization/Bilingual Clinical Triage Liaison/ OR Staff
Lakeland Regional Medical Center
07.2015 - 04.2022
- Company Overview: Medical
- Managed and coordinated all medical authorization processes for a large healthcare facility.
- Developed and implemented workflows and processes for medical authorization requests.
- Communicated with clinical staff regarding authorization requirements and processes.
- Monitored authorization requests and ensured timely completion.
- Maintained accurate medical records and documentation.
- Provided bilingual clinical triage for Spanish speaking patients.
- Responded to patient inquiries in a timely and professional manner.
- Collaborated with medical staff to provide the best possible care for patients.
- OR maintenance & disinfection, restocking, materials, and surgical instruments changes between surgical procedures.
- Medical
Education
Some College (No Degree) - Nursing
Rasmussen University
Brandon, FLSkills
- Communicate with diverse teams and clients
- Build rapport and long-term relationships
- Achieve Client/Customer Satisfaction Metric
- Use varying methods of investigation
- Estimate the cost of repair, replacement, or compensation
- Prepare settlement letters, denial letters, reservation of rights, and other letters as needed
- Resolve liability and coverage condition
- Analyze policy language and coverage to determine liability in each claim
- Negotiate settlements with claimants and attorneys in a timely and efficient manner
- Develop and maintain relationships with clients, attorneys, and other third parties
- Utilize investigations to determine facts in each claim, and recommend appropriate settlement amounts
- Educate clients on insurance policies and best practices for risk management
- Manage and coordinate all medical authorization processes for a large healthcare facility
- Develop and implement workflows and processes for medical authorization requests
- Communicate with clinical staff regarding authorization requirements and processes
- Monitor authorization requests and ensure timely completion
- Maintain accurate medical records and documentation
- Provide bilingual clinical triage for Spanish-speaking patients
- Respond to patient inquiries in a timely and professional manner
- Collaborate with medical staff to provide the best possible care for patients
- Liability
- Claims management
- Service work
- Outstanding ability to multitask and prioritize activities
- Decision-making
- Time management
- File management
- Team collaboration
- Insurance Claims Review
- Claims investigation
- Microsoft Office
- Fraud detection
- Computer literacy
- Data entry
- Verifying insurance
- Company Standards
- Ability to research
- Documenting
- Insurance policies
- Bilingual communication
- Medical documentation
Certification
- 6-20 ACA Claims Adjuster, American Insurance College, 05/01/22
- American Red Cross – Basic Life Support, 01/09/24, Valid 2 years
Languages
Spanish
Full Professional
Timeline
Bilingual CLRU Claims Representative
Progressive
03.2024 - Current
Liability Adjuster
GEICO
05.2022 - 10.2023
Authorization/Bilingual Clinical Triage Liaison/ OR Staff
Lakeland Regional Medical Center
07.2015 - 04.2022
Some College (No Degree) - Nursing
Rasmussen University
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