Reyna Cruz
Sandy Springs,GA
Summary
For the past 10 years, I have built my career at State Farm in claims, managing a wide range of cases with a consistent focus on helping policyholders navigate the claims process. My primary objective has always been to ensure that claims are handled fairly, providing policyholders with the benefits they are entitled to.
Over the years, I have strengthened my skills in communication, problem-solving, and negotiation. My ability to empathize with clients has enabled me to resolve complex cases while maintaining positive relationships. I take pride in contributing to State Farm's mission of helping customers recover from the unexpected.
Overview
11
11
years of professional experience
Work History
Claim Specialist PIP/MPC
State Farm
02.2024 - Current
- Oversee the management of 50+ Personal Injury Protection (PIP) and Medical Payments Coverage (MPC) claims, ensuring accurate evaluation and resolution.
- Investigate and analyze coverage inquiries to determine eligibility for medical benefits in accordance with policy provisions.
- Evaluate and monitor extended treatment claims, verifying that medical care is related to auto accidents and remains medically necessary.
- Collaborate with claims specialists to address multijurisdictional losses, ensuring compliance with statutory guidelines and proper application of coverage based on jurisdiction.
- Provide clear guidance to PIP/MPC associates, streamlining the claims process and enhancing team efficiency.
- Maintain thorough and accurate documentation of claim activities, decisions, and communications for audit readiness.
- Foster strong relationships with medical providers, legal representatives, and insured parties to facilitate effective claims management.
- Stay updated on state-specific PIP/MPC regulations, ensuring compliance and proactive issue resolution.
Claims Specialist HCCS
State Farm Insurance
09.2022 - 02.2024
- Manage over 80 homeowners and renters claims.
- Investigate losses for coverage elibility.
- Skilled in applying fire claims specific guidelines and requirements to ensure accurate claims adjudication.
- Excellent communication and problemsolving skills, with the ability to identify and resolve discrepancies quickly and effectively.
- Maintained detailed records and reports of claims processing and updates
- Ensure policyholders understand their applicable coverage benefits and exclusions.
- Connect policyholders to contractors to streamline claims process.
- Provide direction to associates assisting in handling portion of the claim.
- Settle policyholder's claims as quickly as possible.
PIP/MPC Claims Associate
State Farm
08.2019 - 09.2022
- Reviewed history records to determine benefit eligibility for services.
- Researched medical clailms for validity to resolve discrepancies.
- coordinated benefits with medical insurance plans and Medicare providers.
- Identified client service improvement opportunities in collaboration with team leads and managers to resolve problems.
- Complied with confidentiality regulations in handling customer information.
- Verified claim data correctness in preparation for processing.
- Handled billing related activities focused on medical specialties.
Express Claims Associate
State Farm Insurance
02.2016 - 08.2019
- Briefly worked as a Spanish Express associate and assisted Spanish speaking customers.
- Collaborated with fellow team members to manage large volume of claims.
- Investigated low complexity liability claims involving three vehicles or less.
- Explained policy coverage to insureds and applied policy rules to claims.
- Investigated and approved or denied repairs to questionable damage.
- Worked closely with appraisers, rental facilities, body shops and salvage vendors.
- Processed claims for payment or forwarded to appropriate personnel for further investigation.
- Examined automobile policies with third-party liability, accident benefits and collision benefits.
- Assisted in training new employees on claims processing procedures.
Initial Loss Reporting Associate
State Farm Insurance
10.2014 - 02.2016
- Managed the initial loss reporting process for new and existing claims, including customer contact and data entry.
- Responsible for quickly and accurately entering initial loss notices into the company’s system
- Shared general coverage information with policyholders.
- Provided excellent customer service and attention to customers through phone conversations.
- Collaborated with other departments to ensure timely and accurate communication regarding loss information
Education
Bachelor of Arts - BA - Business Administration and Management,General
The University of Arizona Global Campus
Arizona06-2022
Business Administration and Management - General
Georgia Perimeter College
GeorgiaSkills
- Customer Service
- Communication
- Problem-Solving
- Negotiation Skills
- Conflict Resolution
- Teamwork
- Claims investigation
Timeline
Claim Specialist PIP/MPC
State Farm
02.2024 - Current
Claims Specialist HCCS
State Farm Insurance
09.2022 - 02.2024
PIP/MPC Claims Associate
State Farm
08.2019 - 09.2022
Express Claims Associate
State Farm Insurance
02.2016 - 08.2019
Initial Loss Reporting Associate
State Farm Insurance
10.2014 - 02.2016
Bachelor of Arts - BA - Business Administration and Management,General
The University of Arizona Global Campus
Business Administration and Management - General
Georgia Perimeter College
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