MELISSA CARMONA
JB MDL,USA
Summary
Human Resources Generalist with over 10 years of proven experience in recruiting, training, and evaluating personnel. Recognized as a dynamic trainer for conducting engaging, professional, and technical human resources development classes. Possess extensive knowledge in Human Resources, Operations Management, and Strategic Planning. Military Veteran who recruited and counseled hundreds of prospective and enlisted military members and civilians. Recipient of multiple awards for outstanding performance and professionalism in the United States Army. Career supported by vast analytical and operational experience, training in the military, and a Master of Business Administration in Business Administration and Human Resources Management.
Professional claims specialist with strong record in handling and resolving complex claims efficiently. Adept at analyzing data, identifying discrepancies, and providing solutions that drive positive outcomes. Effective team collaborator with focus on achieving results and adapting to evolving requirements. Skilled in negotiation, customer service, and regulatory compliance, consistently ensuring accuracy and fairness.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Claims Specialist I
Nationwide Insurance
02.2022 - 03.2024
- Handled all assigned claims promptly and effectively with moderate direction and oversight.
- Made decisions within delegated authority as outlined in company policies and procedures.
- Adhered to high standards of professional conduct consistent with the delivery of superior service.
- Initiated and conducted follow-ups via proficient use of claims systems and related business systems.
- Determined proper policy coverages, and where necessary, investigates, evaluates, negotiates and equitably settles all assigned liability/bodily injury claims cases at values commensurate with damages sustained.
- Partnered with Special Investigation Unit and Subrogation to identify fraud and recovery opportunities.
- Maintained and developed current knowledge of assigned insurance lines court decisions which may impact the claims function current guidelines, and policy changes and modifications. This required attendance at various seminars or training sessions.
- Submitted severe incident reports, reinsurance reports and other information to claims management as needed.
- Assisted and prepared files for lawsuit, trial, or subrogation.
- Served as the single point of contact for personal lines material damage claims, including non-standard claims.
- Delivered a positive customer service experience to all internal, external, current and prospective Nationwide customers.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Followed up with customers on unresolved issues.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Demonstrated adaptability by successfully managing a diverse range of claim types, including property damage, bodily injury, liability disputes, and more.
Service Consultant Associate
Progressive Insurance
06.2020 - 12.2020
- Service customer insurance policies with great attention to detail and adherence to state guidelines.
- Resolve customer complaints with consistent follow up to ensure customer satisfaction, as well as ensuring customers are knowledgeable in their policies.
- Process policy changes while maintaining customer rapport and insurance underwriting requirements.
- Process customer payments through various channels, as well as providing knowledge of policy changes that can change policy premiums.
- Adhered to the established security and operational procedures; maintained and oversaw contract specifications.
- Followed established procedures when creating proposals and documents.
- Worked closely with senior management, and other key personnel and contacts for seamless integration of responsibilities and functions.
- Promoted the company’s reputation and attractiveness as a good employment opportunity.
- Remained familiar with open position tasks and responsibilities.
- Remained current on employment legislation and regulations.
- Provided information about service procedures and expected timelines.
- Collaborated with team members to develop new strategies for enhancing customer satisfaction and retention.
- Documented payment details and personal information on customer accounts.
Senior Personal Lines Underwriter
Farmers Insurance Group
06.2015 - 05.2019
- Analyzed, clarified, and resolved auto and home insurance policy concerns and account billing inquiries.
- Communicated with internal and external customers about insurance underwriting guidelines, policies and marketing initiatives to service customer accounts.
- Responded to customer inquiries through appropriate mediums.
- Responsible for reviewing home property inspections to ensure acceptability based on the guidelines for Acceptable Maintenance Condition Expectations (AMCE).
- Reviewed home claim reports and verify all concerns have been remediated to industry standards.
- Assisted with interpreting and communicating personnel policies and procedures during the new hire process.
- Provided accurate information, answers, and maintained quality interactions with appropriate personnel.
- Responsible for accurately monitoring, maintaining, and overseeing reports, documentation, record keeping, correspondence, and communications.
- Maintained and strived to exceed service quantity standards.
- Appropriately coordinated background screening programs as required.
- Attended job fairs and networking events as approved, both in person and online.
- Participated in staff and other meetings as appropriate.
- Supported administrative functions and duties in office for all team members.
- Streamlined communication channels between underwriting, claims, and customer service departments for more efficient operations overall.
- Provided expert guidance on product offerings, helping agents tailor policies to meet individual client needs.
- Improved customer satisfaction through timely and accurate policy evaluations and adjustments.
- Coached junior underwriters on best practices, contributing to their professional growth and development within the organization.
- Conducted thorough reviews of complex insurance applications, ensuring proper coverage and adherence to company policies.
Travel Clerk/ Customer Service Representative
U.S. Army NAF
04.2011 - 02.2012
- Assisted over 50 customers on a daily basis by providing information concerning available leisure activities; sold tickets, made reservations and arranged for special accommodations required for tours, sporting events, theaters and special events.
- Provided full assistance to individuals planning travel itineraries, including hotel reservations and other local services or information.
- Received payments, issued receipts, and documented business transactions.
- Received and transmitted information via electronic mail daily and assisted in organizing and preparing training classes, workshops, and briefings to provide current guidance.
- Coordinated complex multi-destination trips with attention to detail, resulting in seamless travel experiences for clients.
- Enhanced customer satisfaction by efficiently handling travel bookings and addressing inquiries.
Transition Specialist/ Human Resource Specialist (Military)
Serco
02.2007 - 12.2007
- Executed a wide variety of complex technical tasks associated with the release of personnel from active duty, discharges, retirements or physical disability separation from the U.S. Army.
- Trained and proficient in the Department of Defense system’s TRANSPROC III Installation Support Module; meticulously processed both separation orders and DD214s.
- Maintained over 1200 military personnel records and medical and dental records with 100% accuracy; counseled soldiers on preparing for separation and retirement from the military.
- Screened and updated military records and retrieved data from eMILPO and iPERMS.
- Held monthly separation briefings and bi-monthly retirement briefings; ensured all soldiers and retirees were aware of benefits and entitlement to help service members transition into the civilian workforce in accordance with Department of Defense, Army G1, and Human Resources Command (HRC) guidance.
- Served as a point on questions concerning policies, regulations, practices, pertaining to military personnel management programs such as military retirements and ETS leave forms.
- Reviewed, examined, evaluated, and analyzed Department of the Army publications and MILPER messages associated with Military Personnel Management.
- Improved overall client satisfaction by providing tailored assistance, regular updates, and comprehensive support throughout each stage of the transition process.
Supervisory Human Resource Specialist (Military- 42A)
United States Army
01.2003 - 07.2006
- Advised Commander and Human Resource Technician on all matters involving military personnel management.
- Managed administrative office procedures within the Mannheim community for the US Passport and Birth Registration Office; conducted weekly visits to drop off completed packets to the U.S. Consulate in Frankfurt, Germany.
- Completed paperwork for personnel requesting US Passports; assisted both soldiers and civilians in completing US Citizenship paperwork.
- Processed reports of birth abroad packets for US infants born overseas, which included, US Passports, Report of Birth Abroad Birth Certificates, and Social Security Cards.
- Maintained liaison with officials at the Human Resources Command (HRC) for processing Non-Commissioned Officer Evaluation Reports (NCOER).
- Coordinated with the Finance Company to ensure soldiers were paid hazard duty pay while deployed in support of Operation Iraqi Freedom.
- Completed various staff assignments for employees’ permanent change of station (PCS) and various personnel actions, to include adding or removing dependents, Exceptional Family Member Program (EFMP), Early Return of Dependents (EROD), Married Army Couple Program, name changes, and updating Enlisted Record Brief (ERB) and Officer Record Brief (ORB).
- Possessed knowledge of military personnel management systems to include Officer/Enlisted promotions, Officer/Enlisted evaluations, and MILPER Information/ Database, specifically EDAS, eMILPO, and TOPMIS II.
- Updated military service records in accordance with AR 600-8-104 (Soldier Record Brief and iPERMS).
- Kept abreast of current publications on military personnel operations and ensured that policies and procedures for Officer/NCO Evaluations, Awards, Special Pay, and Officer/Enlisted Promotions are current.
- Drafted Standard Operating Procedures (SOP) and information papers for Personnel Service Officer approval.
- S1 Non-Commission Officer during deployment in support of Operation Iraqi Freedom.
- Identified the most effective and efficient way to meet customer needs, improve the assistant personnel management program objectives, to improve service to the customer.
- Managed the social roster, alert roster, OER, NCOERs, EERs, time cards, leaves, calendars, and awards tracking for command team and within the Personnel Service Battalion.
- Continued development of personal and professional skills and established and participated in industry and other professional networks to ensure awareness of regulatory and other trends that may affect the business or direction of the company’s initiatives, policies, and programs.
- Followed up with new hires to assist with turnover reduction.
- Provided customer service support to potential candidates and new hires throughout their interviewing and onboarding process.
- Worked closely with the Human Resource Department to ensure enforcement of recruiting and hiring practice regulations.
- Communicated and coordinated accommodation efforts with the Human Resource Department.
- Oversaw the military leave program and ensured distribution and delivery to and from the installation finance and military personnel directorate.
- Served as a point of contact for policies and procedures, and promotions and evaluations. Ensured an accurate and timely response to all promotion queries. Assisted in decisions in conflicting promotion issues based on regulatory guidance interpretation.
- Used judgment in researching, choosing, interpreting, modifying and applying available guidelines for adaptation to specific issues or problems.
- Provided customer service in the area of entitlements (i.e., Civilian Clothing Allowance, promotions, and school board eligibility, and evaluations). Provided guidance, interpretations, and/ or briefings to units serviced and higher headquarters on current and proposed policies for military personnel action programs.
- Identified current and future hiring needs according to contractual and production goals and obligations.
- Collaborated with department managers to compile a consistent list of requirements.
- Administered job postings across different job platforms.
- Identified useful resources and coordinated referrals.
- Collaborated with cross-functional teams to identify resource gaps and create solutions for streamlined operations.
Education
Master of Business Administration - Business Administration and Human Resources Management
American Intercontinental University
Schaumburg, IL03-2012
Bachelor of Arts - Business Administration
American Intercontinental University
Schaumburg, IL04-2011
Skills
- Microsoft Office
- Microsoft Office Suite
- Word
- Excel
- PowerPoint
- OneNote
- Outlook
- Mac
- Microsoft Windows
- Windows 95
- Windows 98
- Windows XP
- Windows Vista
- Windows 7
- Windows 8
- Enlisted Distribution and Assignment System (EDAS)
- Electronic Military Personnel Office (eMILPO)
- Claims
- Claims processing
- Claims investigation
- Verbal communication
- Microsoft office
- Coverage assessments
- Compliance management
- Settlement determinations
- Claims analysis
- Policy interpretation
- Accident investigations
- Documentation review
- Liability denials
- Complex claims consulting
Certification
Adjuster - Property and Casualty, 2832681, 11/30/26
Additional Work History
U.S. Army, Human Resources Specialist, Ft. Hood, TX, 01/01/00, 12/31/03
Awards
- Army Commendation Medal (HR Specialist Military/ Team Lead)
- National Defense Service Medal
- Global War on Terrorism Expeditionary Medal (Service Operation Iraq)
- Korea Defense Service Medal
Timeline
Claims Specialist I
Nationwide Insurance
02.2022 - 03.2024
Service Consultant Associate
Progressive Insurance
06.2020 - 12.2020
Senior Personal Lines Underwriter
Farmers Insurance Group
06.2015 - 05.2019
Travel Clerk/ Customer Service Representative
U.S. Army NAF
04.2011 - 02.2012
Transition Specialist/ Human Resource Specialist (Military)
Serco
02.2007 - 12.2007
Supervisory Human Resource Specialist (Military- 42A)
United States Army
01.2003 - 07.2006
Master of Business Administration - Business Administration and Human Resources Management
American Intercontinental University
Bachelor of Arts - Business Administration
American Intercontinental University
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