Michelle Alvarado

• Working knowledge of all policies associated with the claims processed in coordination with BayBridge our third party Administrators:
• Familiar with OnBase and other claims systems required for research and claim evaluations
• Medical Coding
• Daily communication with the clients, and their family members, medical providers, risk management departments, HR, and various other outsourced vendors
• MetLife Hospital Indemnity policies, claim process and requirements
• Manhattan/Humana Cancer policies, claim process and requirements
• MetLife Heart and Stroke policies, claim process and requirements
• WellFleet Administrative Duty policies, claims process and requirements
• WellFleet and Humana Accident & Disability Policies, claims process and requirements
• WellFleet, Humana, and ManhattanLife Wellness Claims
• Workers Compensation, claims process, and requirements
• Appeal Reviews
• Familar with process for MRIoA Board for claims requiring further evaluation by a neutral panel of Physicians for continued Accident Medical Expense Benefits and Disability
• Improved interdepartmental communication by establishing clear channels for information sharing between claims administrators, adjusters, and legal teams.
• Continuously updated personal knowledge of industry trends and regulations through ongoing professional development opportunities, contributing to the team''s overall expertise in claims administration.
• Successfully managed multiple projects simultaneously while maintaining focus on deadlines and deliverables.
• Maintained accurate records of all claim-related communications and documentation, ensuring easy retrieval when needed for audits or legal proceedings.
• Promoted a positive work environment within the team by consistently offering support when needed while maintaining a professional demeanor.
• Collaborated with cross-functional teams to develop best practices for claims administration, leading to improved efficiency and reduced errors.
• Reduced claim resolution times by proactively addressing potential issues and effectively communicating with involved parties.
• Streamlined claims processing by implementing efficient administrative procedures and documentation management.
• Effectively negotiated settlements with claimants while maintaining positive relationships on behalf of the organization.
• Maintained strict compliance with industry regulations and company policies during all stages of the claims process, minimizing risk exposure for the organization.
• Managed high volumes of complex claims, demonstrating exceptional attention to detail and organizational skills.
• Investigated, evaluated and adjusted multi-line claims in accordance with standards and laws.

• Part of the Advocacy Team
• Managed team of 16
• Actively worked in both ALR/Guidwire claims platforms
• Successfully answered DOI complains under time demands
• Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
• Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
• Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
• Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.
• Resolved conflicts among team members promptly, maintaining a harmonious working environment conducive to productivity.
• Enhanced communication within the team by holding regular meetings and encouraging open dialogue among all members.
• Collaborated with other departments to achieve organizational goals, fostering teamwork across various functions.
• Conducted performance evaluations for staff members, identifying areas of improvement and guiding professional development plans.
• Implemented safety protocols to minimize workplace accidents and maintain compliance with industry standards.
• Reduced employee turnover by fostering a positive work environment and providing ongoing feedback to staff members.
• Identified operational inefficiencies and implemented corrective measures to increase effectiveness.
• Enhanced team productivity by streamlining workflow processes and implementing efficient scheduling systems.
• Led successful project completions under tight deadlines, coordinating effectively across multiple teams.
• Optimized scheduling to ensure full coverage during peak hours without overstaffing, balancing customer service with cost efficiency.
• Boosted team morale and performance, organizing regular training sessions and motivational meetings.
• Increased customer retention rates by implementing customer feedback into actionable improvements.
• Improved customer satisfaction with prompt and courteous resolution of inquiries and complaints.
• Conducted thorough employee evaluations to identify areas for growth and development, leading to more skilled workforce.

Addressed and answered D.O.I complaints

• Part of Advocacy team
• Worked in both Guldewire &ALR claims system
• Liability reviews, total loss evaluation reviews, payment approvals for teams, and rotation of Manager escalation line, to include Attorney Acknowledgements
• Negotiated vehicle releases
• Resolve complex multi-vehicle liability determination Issues
• Process over [300+] Total Loss claims through resolution (Rideshare Insurance.and Commercial)
• Handle select 1st party attorney represented claims, and bodily injury claims to include gathering information for status of injury, plan for client treatment, and type of treatment for bodily injury adjuster handling
• Manage all aspects of subrogation claims, to include negotiation and recovery efforts of third party casualty claims
• Investigate total theft and theft recovery vehicle claims
• Determine applicable coverage, liability, and coordinate SIU
• Consulted police and hospital records when needed.
• Interviewed claimants and witnesses to gather factual information.
• Examined photographs and statements.
• Provided exceptional customer service during stressful situations, demonstrating empathy, patience, and professionalism throughout the entire claims process.
• Mentored junior adjusters on effective time management and organizational skills, leading to improved work quality and job satisfaction.
• Leveraged industry expertise to provide valuable input during policy revisions, helping develop more comprehensive insurance offerings for clients.
• Optimized workload management, prioritizing time-sensitive cases to ensure timely resolutions for clients.

• Collaborated with repair facilities to negotiate fair and equitable repair costs for insured parties.
• Resolved disputes between insured parties and repair facilities professionally through effective negotiation techniques when necessary.
• Maintained strong relationships with local repair facilities through regular communication and networking efforts.
• Achieved timely and accurate claim settlements by conducting thorough investigations and damage assessments.
• Reduced fraudulent claims by identifying potential fraud indicators during investigations.
• Managed a high volume of claims efficiently, prioritizing tasks for maximum productivity.
• Successfully negotiated settlements with claimants and insurers.
• 10+ Catastrophic Deployments
• Processing of both Auto/Property thefts
• Handling of water loss claims to include mitigation, and personal property.
• Working knowledge of Xactimate.