NATALIE LIMON
San Antonio,Texas
Summary
Knowledgeable Claims Manager with over 7 years of experience bringing planning and problem-solving abilities. Focused on maximizing resource utilization to support scalable operations and increase bottom-line profitability. Organized and systematic with natural relationship-building and leadership talents. Energetic and enthusiastic insurance professional motivated to succeed in fast-paced and deadline-driven professional environment. Comprehensive knowledge of claims adjustments with special knowledge of auto appraisals and CCC pathways estimations. Positive attitude and exceptional problem solving skills. Experienced insurance professional with a 7 year career assessing properties, determining liabilities and negotiating settlements. Detail-oriented, observant, and knowledgeable with excellent interpersonal and documentation skills. Efficiently handle high case volumes with accuracy and care.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Manager of Claims Operations
Allcat Claims Services LLC
San Antonio , Texas
08.2023 - 12.2023
- Managing overall operations in an insurance setting
- Creating and implementing policies to improve and streamline claims processes
- Oversees intake and processing of insurance claims for personal property or casualty loss based on coverage, contractual language, appraisals, and the verifiable coverage
- Review company and team performance to identify areas where individual employees and collaborated departments to improve efficiency
- Determined the value of settlements for escalated complex claims
- Manages subordinate staff in the day-to day performance of the adjuster’s role
- Identifying and minimizing threats as part of ongoing risk management responsibilities
- Managing collected data and creating user-friendly reports that aid executives in identifying company trends and progress by one-on-one coaching and managing individual and team performance
- Continually reviewing state law contracts and policies to confirm that the of the insured and claimants’ needs are best addressed
- Managing all claims investigations
- Trained new team members on policies and procedures for claims handling.
- Assures timely and proper disposition of claims based on policy provisions
- Implement best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations
- Daily monitoring of phone calls, team, and individual diary management for daily performance reporting to the Director level and the Vice President
- Ensured adherence is followed and scheduled daily
- Responsible for implementing performance plans to ensure each adjuster is developing and thriving in their respective role.
- Facilitated training sessions for new hires on the company's claims processing system.
- Coordinated and directed activities of businesses or departments concerning production, pricing and sales.
- Negotiated settlement agreements between claimants and insurance companies when necessary.
- Maintained regular performance appraisals for subordinates through verbal, written and on-going review programs.
- Checked payroll, vendor payments and other accounting disbursements for accuracy and compliance.
- Evaluated and enhanced workflow to implement best practices, reduce costs and increase staff motivation and satisfaction.
- Hired and onboarded team members to meet immediate and expected demand.
- Maintained updated knowledge through continuing education and advanced training.
Bodily Injury Examiner
Carnegie Platinum Claims
Remote , California
03.2023 - 07.2023
- Conducted, coordinate and proactively directed the claim investigation, defense, and settlement of claims
- Managed and maintained a file inventory of 100 to 150 pending timely within the time limit per California State Insurance guidelines
- Reviewed and negotiated the disposition
- Directed field appraisers on task assignment investigations
- Prepared and answered to property damage disputes
- Initiate accurate reserves
- Developed subrogation and third-party recovery
- Reviewed and evaluated claims for the appropriate coding against charges that are billed
- Conferred with attorneys for both first- and third-party claimants regarding coverage, time demands and for the resolution
- Reviewed incoming medical benefits of explanations and compared the billed CPT codes against the claimed injuries for a fair and prompt settlement
- Offered prompt injury settlements to prevent delay in claim handling
- Promptly identified exclusions and investigated thoroughly through recorded statements, along with police reports.
- Thoroughly inspected forms to determine the validity of forms and coverage.
- Compiled evidence from various sources such as medical records, employment histories, and legal documents.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Verified liability extent with reviews of police reports, medical treatment histories and other records.
- Reviewed medical records to determine the appropriateness of services rendered and billed by healthcare providers.
- Investigated discrepancies between estimates provided by third-party vendors and actual repair costs incurred.
- Collaborated with team members on complex cases involving extensive damage assessments.
- Evaluated claims for possible fraud, contacting appropriate department for assistance and further investigation.
- Provided policyholders with advice regarding vehicle repairs and body shop procedures to maximize customer satisfaction.
Bodily Injury Adjuster, Total Loss Adjuster
USAA Insurance
San Antonio , TX
03.2019 - 11.2021
- Actively sought out new sources of information which could be used to support a claim decision.
- Investigated liability issues related to bodily injury claims.
- Interviewed and spoke with claimants, witnesses, police officers, doctors and other parties to determine claim settlement or denial.
- Reviewed data to verify validity of claims and determine case management actions.
- Assessed medical records and other relevant documents to determine the extent of injuries sustained.
- Evaluated and processed bodily injury claims according to company guidelines.
- Ensured compliance with applicable regulations governing the processing of bodily injury claims.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
- Maintained updated knowledge through continuing education and advanced training.
- Collaborated with others to discuss new opportunities.
- Negotiated and settled claims according to information presented through reports, research, and data verification.
- Input claim information and payments into company database.
- Communicated with personnel and legal counsel on claims involving litigation.
- Identified and collected evidence and determined value to specific claim to properly assess conditions.
- Interacted with claimants, witnesses, attorneys and other parties involved in the claim process.
- Reviewed estimates prepared by appraisers or auto body shops regarding the cost of repairs to vehicles involved in total loss claims.
- Recognized by management for providing exceptional customer service.
- Estimated benefit payments for each incident.
- Investigated and documented liability, coverage, and damages related to total loss claims.
- Negotiated settlements with customers and lien holders paid out total loss settlements and obtained necessary documents to process titles for branding.
- Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
- Collaborated with attorneys and insurance companies to develop effective solutions for complex subrogation matters.
- Performed cost and benefit analysis on various settlement offers prior to making recommendations.
- Adhered strictly to company policies regarding confidentiality and data security measures.
- Reviewed police reports, medical treatment records, medical bills and physical property damage to determine extent of liability.
- Negotiated settlements between claimants and insurers while ensuring fair compensation was provided in a timely manner.
- Resolved repair cost inquiries, consulting with various appraisers for second opinions to resolve disagreements.
- Advised clients on appropriate course of action based on individual circumstances.
- Evaluated facts of the case to determine extent of liability and damages.
- Adhered strictly to company standards when evaluating cases for payment authorization.
- Investigated inconsistencies in documentation or reports obtained from third parties.
- Held interviews with witnesses and resorted to looking up hospital and police records when needed.
- Ensured that all required notifications were sent out promptly following decisions on claims.
- Identified potential fraud by analyzing data for any irregularities or discrepancies.
- Researched complex issues related to specific cases involving multiple parties or unusual circumstances.
- Conducted interviews with claimants, employers, physicians and other healthcare providers to obtain additional information relevant to the claim.
- Completed day-to-day duties accurately and efficiently.
Medical Claims Adjuster
UMR
San Antonio , TX
07.2017 - 02.2019
- Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.
- Performed data entry into electronic health record system for all relevant patient information including diagnoses, procedures performed, medications prescribed .
- Interpreted medical terminology and pharmacological information to translate information into coding system.
- Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
- Conducted audits of medical records to identify missing or incorrect documentation that could affect accurate coding and billing.
- Transmitted information or documents to customers through email, mailings or facsimile machine.
- Provided customer service support via phone or email regarding account balances or other inquiries related to billing issues.
- Trained new employees on medical coding practices.
- Processed benefit enrollment forms, changes, and terminations.
- Processed invoices from vendors providing services related to benefit administration.
- Provided assistance to plan participants by explaining benefits information to ensure educated selections.
- Coordinated benefits processing, including enrollments, terminations and claims.
- Developed and evaluated methods and techniques for selecting, promoting and training workers.
- Created and offered additional materials to enhance training.
- Monitored progress of trainees to ensure they were meeting goals and objectives set forth by management.
- Developed assessment tools to measure the effectiveness of the new hire training program.
- Collaborated with managers on individualized learning plans for each new hire to ensure success in their role.
- Conducted training sessions to ensure successful integration of new employees into the organization.
- Assisted in developing an effective orientation process for incoming staff members.
- Organized team building activities to foster collaboration among newly hired personnel.
- Held regular one-on-one coaching sessions with staff members to encourage personal development.
- Supervised classroom during training delivery to determine if staff followed classroom guidelines and fulfilled necessary requirements of course objectives.
- Communicated with reinsurance brokers to obtain claim information for processing.
Education
Some College (No Degree) - Pre-Law
University of The Incarnate Word
San Antonio, TXCore curriculum hours with an emphasis on Psychology, Political Science and Communications -
San Antonio College
Some College (No Degree) -
William Rainey Harper College
Palatine, ILSome College (No Degree) -
Oakton Community College
Skokie, ILSkills
- KPI Tracking
- Performance Improvement
- Teamwork and Collaboration
- Performance Improvements
- Team Leadership
- Training Management
- Systems Implementation
- Customer Service
- Hiring and Onboarding
- Performance Evaluations
- Business Growth Initiatives
- Management Team Building
- Relationship Building
- Performance Evaluation and Monitoring
- Employee Motivation
- Customer Relations
- Desktops, Laptops, and Mobile Devices
- Employee Relations
- Revenue Growth
- Goal Setting
- Decision-Making
- Staff Hiring
- Negotiation
- Policy Enforcement
- Staff Discipline
- Staff Development
- Learning Techniques
- Skills Development
- Compliance
- Background in Property and Casualty
- Proficient in Microsoft Suite
- Staff Collaboration
- Collaboration and Teamwork
- Project Management
- Policy Interpretation
- Investigative Skills
- Insurance Knowledge
- Liability Determination
- Settlement Negotiations
- Policy Investigations
- Property Claims
- Benefit Explanation
- Coaching and Mentoring
- Staff Management
- Risk Management
- Customer Service and Support
- Interview Techniques
- Quality Assurance
- Time Management
- Liability Knowledge
- Billing
- Claims Handling
- Fraud Detection Knowledge
- Eligibility Determination
- Insurance Terminology
- Coverage Determination
- Insurance Coverage Verification
- Regulatory Compliance Adherence
- Medicaid Knowledge
- Understanding of Medical Terms
- Policy Analysis
- Payment and Investigation Escalations
- Policy Review
- Conducting Investigations
- Reserves Recommendations
- Task Delegation
- Medical Coding
- Risk Assessment
- Claims Investigation
- Persuasive Negotiation
- Property and Casualty Insurance
- Legal Knowledge
- Insurance Policies
- Automobile Appraisals
- Claims Processing
- Claims Investigations
- Legal Compliance
- Quality Control
Hobbies and Interests
sponsored body building athelte active in body building competitions. studying various aspects of law physical fitness nutrition coaching
Affiliations
- Body Building Competitor
- Law Enthusiast
Certification
- Property and Casualty
Timeline
Manager of Claims Operations
Allcat Claims Services LLC
08.2023 - 12.2023
Bodily Injury Examiner
Carnegie Platinum Claims
03.2023 - 07.2023
Bodily Injury Adjuster, Total Loss Adjuster
USAA Insurance
03.2019 - 11.2021
Medical Claims Adjuster
UMR
07.2017 - 02.2019
Some College (No Degree) - Pre-Law
University of The Incarnate Word
Core curriculum hours with an emphasis on Psychology, Political Science and Communications -
San Antonio College
Some College (No Degree) -
William Rainey Harper College
Some College (No Degree) -
Oakton Community College
- Property and Casualty
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