Summary
Overview
Work History
Education
Skills
Professionalskillsandqualifications
Timeline
Generic

Michele Smaldone

Loomis,CA

Summary

A dedicated Claims Specialist with a strong service-oriented mindset, excelling in utilizing innovative strategies to tackle intricate and detailed challenges. Focusing on building strong relationships with both customers and colleagues, ensuring open communication and collaboration. Delivering outstanding customer service, making sure that every interaction is positive and productive.

Overview

10
10
years of professional experience

Work History

Sr. Long Term Disability Claims Representative

MetLife
07.2019 - Current
  • I manage LTD claims from their inception to final resolution. I gather, assess, and interpret policy details, as well as medical, occupational, and financial data, to ascertain both initial and ongoing eligibility for coverage. Each claim is evaluated with a focus on the possibility of returning to work, and I leverage our rehabilitation and medical resources whenever feasible. Additionally, I assist in mentoring and training newer team members.

Subrogation Business Analyst

Esurance
10.2018 - 07.2019
  • Gathered and examined data to uncover trends for possible collections. Assessed workflows of subrogation and arbitration teams to enhance process efficiency. Acting as liaison among departments such as actuarial, legal, IT, and underwriting, facilitated seamless data reporting. Conducted audits and analyses of claims for Michigan PIP reinsurance reimbursement. Additionally, Presided over arbitration cases for Arbitration Forums and provided mentorship to new team members and those aspiring to advance in their roles.

Arbitration Analyst

Esurance
12.2017 - 10.2018
  • Assessed and evaluated arbitration potential for all assigned cases. Submitted and responded to cases in Arbitration Forums, advocating for facts of each claim to secure favorable results for company. Adjudicated claims in Arbitration Forums, making determinations on liability and damages related to automobile incidents. Collaborated with insured clients, field personnel, investigative agencies, and vendors to achieve resolutions for files.

Subrogation Specialist

Esurance
11.2014 - 12.2017
  • Assessed and evaluated subrogation opportunities for all assigned cases. Facilitated negotiations regarding liability, settlements, and payment plans. Adjudicated cases for Arbitration Forums, making determinations on liability and damages for auto claims. Collaborated with insured clients, field personnel, investigative agencies, and vendors to achieve resolutions for files.

Attorney Rep Adjuster (Temp)

Esurance
08.2014 - 10.2014
  • Managed Property Damage excess claims, assessing coverage and liability to identify all potential exposures while negotiating settlements with both individuals and insurance companies.

Education

Bachelor of Arts - Communications

UC Davis
Davis, CA

ARMY ROTC -

UC Davis
Davis

Skills

  • Decision-making capabilities
  • Quality control monitoring
  • Organizational abilities
  • Medical terminology expertise
  • Conflict resolution techniques
  • Documentation proficiency
  • Client Interviewing
  • Coverage Assessment
  • Active Listening
  • Relationship Building
  • Decision-Making
  • Critical Thinking

Professionalskillsandqualifications

  • Disability Claims Experience
  • Customer Focused
  • Liability decision making
  • Action Oriented
  • Coverage and Contract analysis
  • Team Player
  • Excellent working knowledge of Word, Excel, Powerpoint
  • Quick Learner
  • Mentoring and Training
  • Building Chemistry

Timeline

Sr. Long Term Disability Claims Representative

MetLife
07.2019 - Current

Subrogation Business Analyst

Esurance
10.2018 - 07.2019

Arbitration Analyst

Esurance
12.2017 - 10.2018

Subrogation Specialist

Esurance
11.2014 - 12.2017

Attorney Rep Adjuster (Temp)

Esurance
08.2014 - 10.2014

Bachelor of Arts - Communications

UC Davis

ARMY ROTC -

UC Davis

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Michele Smaldone