Rakira Esters
Frisco,TX
Summary
Motivated service-oriented specialist, focused on creating a positive experience to ensure top quality service for customer resolution. Accustomed to working in fast-paced environments with the ability to think and act quickly. Experienced in research and investigation, negotiations, attention to details, and results oriented.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Claims Specialist - Injury
State Farm
Richardson, Tx
02.2024 - Current
- Researched medical records to evaluate claim validity and verify the existence of pre-existing conditions.
- Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
- Investigated complex or high-value claims to identify discrepancies and fraud indicators.
- Processed payments for valid claims according to established procedures.
- Facilitated communication between claimants, providers, attorneys, adjusters, employers, and other parties involved in a claim.
- Interpreted legal documents related to claims processing such as contracts and policy language.
- Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
- Provided customer service by responding promptly to inquiries from claimants regarding their benefits or coverage.
- Analyzed settlement offers against liability limits set by insurers.
- Resolved disputes between claimants and providers through negotiation.
- Conducted interviews with involved claims parties and witnesses to gather detailed information and arrange investigations.
Commercial Claims Adjuster
Zurich American Insurance
Dallas, TX
04.2022 - 01.2024
- Reviewed and processed auto claims documents to ensure accuracy of information.
- Assessed the validity of claims and determined appropriate action based on policy provisions.
- Conducted investigations, gathered evidence, and interviewed witnesses to determine liability in auto accident cases.
- Investigated commercial property claims, gathering facts and documents to determine coverage.
- Assessed damage and estimated costs for repairs or replacement of damaged items.
- Researched applicable policies to evaluate the extent of coverage and liability.
- Interacted with clients, attorneys, contractors and other parties involved in a claim process.
- Reviewed invoices submitted by contractors for accuracy before authorizing payment.
- Negotiated and settled claims according to information presented through reports, research and data verification.
- Completed required investigations on referred files within established timeframes.
- Investigated questionable claims to determine payment authorization.
- Gathered information from various third parties to determine claim acceptability.
Customer Service Specialist
Capital One
Plano, TX
11.2020 - 04.2022
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Documented conversations with customers to track requests, problems and solutions.
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
- Assist customers with completing refinance pre-qualification process.
- Experience collaborating with and delivering results to multiple stakeholders.
- Experience with grievance administration, including settlement negotiations and contribution toward preparation and/or arbitration advocacy.
- Executes case preparation and analysis, develops risk mitigation and settlement strategy, and ensures stakeholder alignment.
- Build effective customer-company relations.
- Successfully influence and negotiate the company’s best interest to achieve negotiation outcomes.
- Effectively work with all levels of leadership, employees, and peers.
Claims Adjuster
Confie Seguros Inc.
Irving, TX
11.2019 - 05.2020
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Contacted injured parties and legal representatives to negotiate final settlements for claims
- Worked with underwriting on loss reserves and risk assessment and coordinated field reviews
- Adhered to company and insurance client’s guidelines in claims processes, estimate writing and claim closures
- Obtained all necessary information to complete proper evaluation of injury claims
- Conducted claim and estimate re-inspections
- Completed required investigations on referred files in timely manner
- Obtained relevant evidence and information regarding suspicious claims
Education
Bachelor of Science - Business Administration
The University of Southern Mississippi
Hattiesburg, MS08.2018
Skills
- Inventory tracking
- Strong interpersonal and communication skills
- Team player
- Property claims
- Proficient in MS Office
- Advanced mathematical aptitude
- Inbound and outbound calling
- Customer service
- Department coordination
- Quality improvements
- Planning and coordination
- Relationship development
- Organization
- Leadership development
- Conflict resolution
- Risk Mitigation
Certification
Licensed Property and Casualty All Lines Adjuster in the state of Texas
Skills
- Inventory tracking
- Strong interpersonal and communication skills
- Team player
- Property claims
- Proficient in MS Office
- Advanced mathematical aptitude
- Inbound and outbound calling
- Customer service
- Department coordination
- Quality improvements.
- Planning and coordination
- Relationship development
- Organization
- Leadership development
- Conflict resolution
- Risk Mitigation
Timeline
Claims Specialist - Injury
State Farm
02.2024 - Current
Commercial Claims Adjuster
Zurich American Insurance
04.2022 - 01.2024
Customer Service Specialist
Capital One
11.2020 - 04.2022
Claims Adjuster
Confie Seguros Inc.
11.2019 - 05.2020
Bachelor of Science - Business Administration
The University of Southern Mississippi
Licensed Property and Casualty All Lines Adjuster in the state of Texas
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