Paris Flores
Aubrey,TX
Summary
Knowledgeable licensed claims adjuster with strong background in assessing and resolving bodily injury claims efficiently and fairly. Handles complex cases with precision and ensures compliance with regulations. Demonstrates strong negotiation and analytical skills to deliver optimal outcomes and maintain high client satisfaction.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Bodily Injury Claims Adjuster
Bridger Insurance Services
Dallas, TX
07.2024 - Current
- Negotiated terms and handled settlements and adjustments with attorneys, claimants and co-defenders.
- Interviewed relevant parties to determine claim denial or settlement.
- Interviewed policyholders, witnesses and third parties to gather information and details regarding injury event.
- Evaluated coverage, liability and damages and investigated suspicious claims.
- Participated in ongoing training programs to stay up-to-date on industry trends, regulatory changes, and best practices for bodily injury claims handling.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
Bodily Injury Claims Adjuster II
Allstate/ National General
Remote
08.2024 - 12.2024
- Negotiated terms and handled settlements and adjustments with attorneys, claimants and co-defenders.
- Improved claim resolution times by efficiently managing a caseload of 100-250 bodily injury claims.
- Reviewed medical treatment reports, and medical bills in
- Handled various injuries from minor soft tissue injury extending to complex injuries; including fatalities.
- Enhanced customer satisfaction by providing timely updates on claim status and answering inquiries professionally.
- Referred extreme cases to Special Investigation Unit (SIU) for further review.
- Documented and tracked claims approval process and communicated status monthly with claimants, attorneys and in-house personnel.
- Utilized resources to review and respond to Bodily Injury demands and present fair and reasonable settlement offers
Bodily Injury Claims Adjuster
Platinum Claims Services
Newbury Park, CA
12.2021 - 06.2024
- Interviewed and spoke with insured driver,claimants, witnesses, and claimant carrier to obtain the fact of the loss and determine claim settlement or denial.
- Investigated and assessed property damage.
- Obtained necessary information to complete proper evaluation of injury claims.
- Handled attorney-repped and non -attorney repped files.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Review and cleared coverage
- Multi tasked with various computer program
- Provided excellent customer service to customers via phone and email.
Liability Claims Adjuster
Progressive Insurance
Sacramento, CA
08.2019 - 07.2021
- Handled entire claim file from initial claim reporting to closing.
- Reviewed and cleared any existing coverage issues.
- Conducted thorough investigation to determine liability.
- Made telephone contact with all parties involved in the loss.
- Made liability determinations based on presented facts and evidence.
- Handled total loss files
- Reviewed files for any SIU alerts .
- Provided excellent customer service.
Claims Processor
Health Net
Sacramento, CA
11.2017 - 05.2019
- Full time contract position.
- Processed professional and institutional claims for VA and Medi-Cal/Medicaid recipients.
- Identified and resolved any pend codes preventing claim from processing thoroughly
- Researched and identified payments not allocated properly and applied to appropriate claim.
- Provided authorization for treatment request from providers.
- Made outgoing and took ingoing calls from providers and patients.
- Gathered any necessary information needed to complete the claim .
Call Center Representative
Sprint
Rancho Cordova, CA
04.2012 - 03.2014
- Answered incoming calls and provided highest level of professionalism and knowledgeable service to every customer.
- Updated customer accounts, addresses and contact information within call management databases.
- Engaged actively with callers, confirming or clarifying information and diffusing anger.
- Offered resolutions to de-escalate calls and solve customer issues.
- Met or exceeded call speed, accuracy and volume benchmarks on consistent basis.
- Consulted with customers to resolve service and billing issues.
Education
High School Diploma -
Elk Grove Adult & Community Education
Sacramento, CA06.2003
Skills
- Customer Service
- CRM Software
- Efficient and Detail-Oriented
- Issue and Complaint Resolution
- Liability Determination
- Verbal and Written Communication
- Complex Problem Solving
- Claims Processing
- Administrative Support
- Multitasking and Prioritization
- Microsoft Office Suite
- Claims investigation
- Insurance policy coverage knowledge
- Settlement negotiation
- Medical records analysis
- Liability assessment
- Negotiation
- Policy interpretation
- Damage evaluation
- Proficiency of bodily injury claims
- Total loss handling
- Customer service
- Insurance regulations
- Problem-solving
- Highly motivated
- Attention to detail
- Multitasking and organization
- Critical thinking
- Verbal and written communication
- Claims processing
- Caseload management
Certification
- All Lines Claims Adjuster License -Texas
Timeline
Bodily Injury Claims Adjuster II
Allstate/ National General
08.2024 - 12.2024
Bodily Injury Claims Adjuster
Bridger Insurance Services
07.2024 - Current
Bodily Injury Claims Adjuster
Platinum Claims Services
12.2021 - 06.2024
Liability Claims Adjuster
Progressive Insurance
08.2019 - 07.2021
Claims Processor
Health Net
11.2017 - 05.2019
Call Center Representative
Sprint
04.2012 - 03.2014
High School Diploma -
Elk Grove Adult & Community Education