Mona Lisa Urbina

Developed effective techniques to mitigate losses.
Developed and maintained working relationships with independent
adjusters and contractors to assist in prompt claims handling.
Prepared sketch of floor plan and roofline and entered data into XACT to
develop line-by-line item costs of damages.
Scoped and photographed properties for defects and damage.
Used Guide wire to compile estimates for personal property and structure
damage.
Coordinated and managed field investigations, outside engineers,
contractors and cause and origin experts.
Carefully reviewed claim information to verify accuracy and avert
fraudulent claims.
Examined claims forms and other records to determine insurance
coverage.
Assisted homeowners by coordinating vendor services, emergency repair,
cleaning and contractors

• Substantiated legitimate claims and denied unjustified claims.
• Interviewed claimants and witnesses to gather factual information.
• Researched and analyzed policy contracts to verify proper payment of claims.
• Maintained suspicious claims database and prepared reports for supervisors.
• Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
• Examined claims forms and other records to determine insurance coverage.
• Investigated and processed insurance claims for policyholders.
• Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
• Prepared summaries of damage, payments, and policy coverage.
• Evaluated insurance policies and analyzed damages to determine coverage.
• Examined photographs and statements.
• Investigated properties to determine extent of damage and estimate repair costs.
• Established relationships with clients and insurance companies to foster timely claims resolution.

• Defined and implemented quality initiatives to reduce risk.
• Recorded findings of inspection process, collaborating with quality team to implement corrective actions.
• Monitored KPIs to proactively address bottlenecks and quality issues.
• Developed training materials, SOPs and work instructions to supplement new team member onboarding.
• Participated in departmental meetings to establish short- and long-term strategy.
• Led process improvement projects to help operations meet and exceed quality standards and reduce costs.
• Compiled and distributed weekly feedback to team leaders and managers to improve service time and quality while increasing productivity.
• Created and collaborated in implementation and maintenance of customer complaint log.
• Edited, proofed and critiqued internal documents to improve clarity.
• Created and revised procedures, checklists and job aids to reduce errors.
• Developed and maintained quality assurance procedure documentation.
• Analyzed quality and performance data to support operational decision-making.
• Collaborated with management to provide training on improved processes and assisted with creation and maintenance of quality training.

• Analyzed information gathered by investigation and reported findings and recommendations.
• Identified key areas not performing well and implemented effective, new processes.
• Verified accuracy of loss records to maintain accuracy of records database.
• Reviewed new files to determine current status of injury claim and to develop plan of action.
• Identified suspicious losses and contacted manager for investigative assistance.
• Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
• Established productive working relationships with public officials and law enforcement officers.
• Resolved complex, severe exposure claims using high service oriented file handling.
• Examined claims forms and other records to determine insurance coverage.
• Followed up with insured individuals regarding premium and deductibles payments.
• Interacted with clients and employees, which helped cultivate positive working relationships.
• Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
• Synthesized data into comprehensive quarterly written reports for management.
• Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
• Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
• Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.

• Assisted in recruitment of new team members, hiring highest qualified to build team of top performers.
• Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
• Reviewed, implemented and updated company records related to team activities for future reference.
• Mentored and guided employees to foster proper completion of assigned duties.
• Interpreted conversations between foreign language-speaking clients and others.
• Reviewed final work to spot and correct errors in punctuation, grammar and translation.
• Created detailed reports on accuracy of translated documents.
• Completed precise translations of official documents with correct words and phrasing to meet legal standards.
• Collaborated with team to translate series of documents from English to other languages.
• Assisted foreign language-speaking clients with inquiries.
• Examined claims forms and other records to determine insurance coverage.
• Prepared summaries of damage, payments, and policy coverage.
• Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
• Conducted comprehensive interviews of witnesses and claimants to gather facts and information.

• Responded to customer calls swiftly to resolve issues and answer questions.
• Utilized CRM software to manage client relationships.
• Created detailed reports for management to track performance and sales.
• Investigated and processed claims swiftly to keep customers satisfied.
• Obtained underwriting approval by completing application for coverage.
• Processed eligibility and benefits verification and authorization requests.
• Determined client needs and financial situations by listening and scheduling fact-finding appointments.
• Followed up on denials, late payments, extensions and other special circumstances.
• Researched and resolved routine and complex issues.
• Built relationships with clients using active listening and issue resolution to provide excellent service.
• Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
• Resolved discrepancies in insurance payments by collaborating with carriers.

• Made contact with insurance carriers to discuss policies and individual patient benefits.
• Posted payments to accounts and maintained records.
• Maintained strong knowledge of basic medical terminology to better understand services and procedures.
• Communicated verification and authorization status updates with Sub team department to facilitate decision-making for patient admissions and insurance coverage.
• Conducted Sworn written statements.
• Profit and Loss statements documents.
• Reviewed and analyzed suspicious fraudulent on potential insurance claims.
• Provide reimbursement and losses in ALE according to each claimant.
• Translated Vietnamese and Spanish documents for claimants.
• Determine the cause of damage and provide reimbursement from the overflow oil spill damages.
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