M. Iveth Cruz-Hernandez
Reno,NV
Summary
Diligent Claims Adjuster with a Nevada license and a proven track record at Associated Risk Management. Expert in claims evaluation and processing, utilizing critical thinking and advanced communication skills to enhance customer satisfaction. Successfully streamlined workflows, achieving high efficiency in claims resolution while maintaining compliance with legal standards.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Claims Adjuster/Medical Claims Examiner
Associated Risk Management
Carson City, NV
10.2022 - 04.2026
- Evaluated complex insurance claims for accuracy and compliance with policy guidelines.
- Collaborated with clients to gather necessary documentation and clarify claim details.
- Analyzed loss data to determine liability and coverage applicability for claims resolution.
- Utilized claims management software to track progress and maintain accurate records.
- Communicated effectively with stakeholders, including policyholders and legal representatives, throughout claims process.
- Developed strategies to streamline workflows, enhancing efficiency in claim processing operations.
- Examined claims forms and other records to determine insurance coverage.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Contributed to a positive work environment through active participation in team meetings and collaborating on cross-functional projects.
- Provided exceptional customer service during emotionally difficult situations for policyholders following accidents or natural disasters.
- Achieved high customer satisfaction ratings by providing clear and timely communication throughout the claims process.
- Attended industry conferences and workshops to stay current on trends and developments within the field of claims adjusting.
Nurse Case Manager Assistant/Medical Interpreter
Goodrich Consulting
Reno, NV
10.2010 - 10.2021
- Led patient care coordination efforts to optimize treatment plans and improve health outcomes.
- Developed individualized care strategies, addressing complex medical needs of diverse patient populations.
- Conducted comprehensive assessments to identify barriers to effective care and implemented solutions.
- Collaborated with multidisciplinary teams to enhance communication and ensure continuity of care.
- Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.
- Arranged transportation and documented details of discharge transition plans.
- Identified opportunities to optimize communication within inpatient and cross-continuum teams to drive effective patient flow and sustainable care transitions from hospital and home, within community care settings and implement supplemental care and services for high-risk patients.
- Streamlined workflow efficiency by collaborating with team members to optimize utilization of resources and prevent gaps in care.
- Developed strong relationships with patients and their families, providing emotional support during challenging
- Educated family members and caregivers on patient care instructions.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Medical Assistant/Spanish Medical Interpreter
Concentra Urgent Care
Sparks, NV
06.2008 - 09.2011
- Administered patient assessments and vital sign checks to ensure accurate clinical data collection.
- Assisted healthcare providers with examinations, enhancing patient care efficiency and comfort.
- Provided patient education on treatment plans and preventative care strategies, fostering informed decision-making.
- Trained new staff on clinical procedures and office protocols, promoting team cohesion and operational effectiveness.
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Built strong relationships with patients through effective communication skills that foster trust in the clinic''s commitment to quality care.
- Maintained a safe and clean clinical environment by adhering to infection control guidelines and disposing of biohazardous waste properly.
- Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
- Ensured patient safety and comfort during examinations, effectively addressing concerns and answering questions.
- Boosted patient satisfaction by providing compassionate care and promptly addressing needs during visits.
- Performed phlebotomy tasks efficiently while ensuring minimal discomfort for patients during blood collection procedures.
- Enhanced clinic efficiency by assisting physicians with routine procedures and diagnostic tests.
- Contributed to positive health outcomes by educating patients on preventative measures, treatment plans, and follow-up care instructions.
- Aided in accurate diagnoses by performing laboratory tests and preparing specimens for analysis.
- Reduced wait times by swiftly processing insurance claims, verifying coverage, and obtaining pre-authorizations when necessary.
Education
Associate of Science - Medical Assisting
Career College of Northern Nevada
05-2005
Certified Air Traffic Controller - Aviation
US ARMY School of Aviation
Fort Rucker, AL06-1994
Skills
- Critical thinking
- Claims investigation
- Active listening
- Highly motivated
- Team collaboration
- Claims processing
- Advanced oral and written communication skills
- Decision-making
- Caseload management
- Policy interpretation
- Nevada claims adjuster license
- Legal compliance
- Record preparation
- Customer service
- Problem-solving
- Attention to detail
- Multitasking and organization
- Empathy and patience
- Verbal and written communication
- Data entry
- Ethical judgment
- Workflow management
- Claims file documentation
- Workers' compensation claims
- Settlement management
- Medical terminology specialist
- Customer service and support
- Tme management
- Computer skills
- Claims adjustment
- Claims
- Claims evaluation
- MS office
- Payment processing
Accomplishments
Licensed Claims Adjusters, Examiners, and Investigators-
Certification
- Licensed Claims Adjuster - two and a half years
Languages
Spanish
Native or Bilingual
Spanish
Full Professional
Interests
- Dancing
- Participating in fundraising events to support local charities, schools, or community projects
- Yoga
- Team Sports
- Volunteer Work
- Volunteering with youth sports programs as a Volleyball Coach
- DIY and Home Improvement
- Playing Sports
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Claims Adjuster/Medical Claims Examiner
Associated Risk Management
10.2022 - 04.2026
Nurse Case Manager Assistant/Medical Interpreter
Goodrich Consulting
10.2010 - 10.2021
Medical Assistant/Spanish Medical Interpreter
Concentra Urgent Care
06.2008 - 09.2011
Associate of Science - Medical Assisting
Career College of Northern Nevada
Certified Air Traffic Controller - Aviation
US ARMY School of Aviation