Ranfis-Micael Lemus

• Followed up with customers on unresolved issues.
• Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
• Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
• Evaluated and settled complex insurance claims in strict timeframes.
• Posted payments to accounts and maintained records.
• Verified client information by analyzing existing evidence on file.
• Coordinated with contracting department to resolve payer issues.
• Generated, posted and attached information to claim files.
• Closing up to 25 claims a week and handling 25-30 calls a day.

Extensive experience in investigating, evaluating, negotiating and settling claims. Correctly applying knowledge of policies, insurance regulations when determining coverage and liability. Upwards of 25-30 calls a day.

• Processed, reviewed, and evaluated incoming insurance claims in both English and Spanish
• Researched and answered customer inquiries regarding claims in a timely and accurate manner
• Maintained knowledge of applicable laws, regulations, and standards governing insurance claims
• Developed and maintained relationships with insurance companies and customers to ensure accurate and timely resolution of claims
• Utilized a variety of software programs to access and analyze claims data
• Negotiated settlement of claims with insurance companies and customers

Supplementing insurance carriers original estimates to cover actual costs associated with repairs to dwelling. Working on 15-20 supplements a week.

• Negotiating with insurance carriers to optimize claim settlements, up to 20-25 calls a day.
• Investigating of pertinent evidence for successful supplement submission.
• Proper reconciliation of accounts via work orders, labor and material estimates for timely release of recoverable depreciation.
• Coordinate and facilitate processing of claims and review estimates with third party claims administrators.

Review of field reports to determine insurable damages and submission of claims while procuring necessary documentation to substantiate claims, such as Statements of Loss.

• Appraisal desk review, assessment and correction. Identify and analyze direct loss and indirect loss, including subrogation of losses and submission processes. Doing 40 property valuations daily and submitting 30-40 claims submissions on distressed properties.
• Generation valuations and estimates via xactware/xactimate to assign correct RCV/ACV for subject properties.
• Risk assessment, identification and submission of claims while identifying conditions, exclusions and insuring agreements of various insurance policies and jurisdictional references.