Rita D. Valencia
Sachse,TX
Summary
Accomplished Supervisor focused on meeting customer expectations and achieving company goals. Drives success by directing high-producing teams while developing lasting employee rapport. Exceptional knowledge of cost-reduction methods and streamlining production processes.
Overview
19
19
years of professional experience
Work History
Auto Claims Supervisor
Seaharbor Insurance
12.2022 - Current
- Monitored workflow to improve employee time management and increase productivity.
- Maintained clean and well-organized production areas to avoid violations or unnecessary work delays due to hazards or inefficient layouts.
- Enforced rules and regulations outlined in company manual to set forth expectations comprehensibly and consistently.
- Created successful work schedules for each team member to maintain deadlines and fully staff shifts.
- Evaluated employee performance and coached and trained to improve weak areas.
- Boosted team performance by developing customer service training materials and conducting service training.
- Conducted regular reviews of operations and identified areas for improvement.
- Assisted with periodic investigation of questionable claims (SIU).
- Prepared weekly reports of all claims activities.
- Confirm claim files are reserved adequately on new and existing claims.
- Established performance plans.
- Performed internal audits as requested by management.
- Review and release adjuster payments.
- Review non-cooperation denials and approve denials.
- Insured all risk alerts are being reported to underwriting.
- Review all missed represented application before forwarding to management for approval.
- Monitored team performance, enforcing compliance with corporate claims processes and procedures.
- Investigated, evaluated and adjusted multi-line claims in accordance with standards and laws.
- Determined proper course of action for claims processing.
- Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
Bodily Injury Claims Adjuster
State Farm
06.2016 - 12.2022
- Evaluated coverage, liability and damages and investigated suspicious claims.
- Conducted claims investigations by obtaining written statements, preparing reports, researching public records and conducting personal interviews.
- Reviewed medical treatment reports, police reports, and medical bills.
- Interpreted policy details and recommended most favorable course of action.
- Estimated cost of filing claims and applicable court or legal fees for claimant party.
- 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.
- Determined liability and estimated and approved benefit payments.
- Negotiated terms and handled settlements and adjustments with attorneys, claimants and co-defenders.
- Examined forms to determine insurance coverage.
- Monitored expenses of pending claims to comply with company expenditure guidelines and budgets.
- Interviewed policyholders, witnesses and third parties to gather information and details regarding injury event.
- Verified insurance claims and determined fair amount for settlement.
Senior Customer Service Representative
Blue Cross Of California
01.2005 - 12.2014
- Trained and directed new employees in call script use, conflict resolution, and data entry practices to boost customer satisfaction ratings.
- Escalated issues to proper supervisors when standard processes were not effective.
- Researched and rapidly resolved client conflicts to maintain key accounts.
- Resolved customer service issues using company processes and policies and provided updates to customers.
- Engaged clients in person and over phone to answer questions and address complaints.
- Responded to customer calls and emails to answer questions about products and services.
- Met customer call guidelines for service levels, handle time and productivity.
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Worked with fully funded/self funded plans.
- PPO, HMO, POS and HSA plans.
Education
Bachelor of Science - Business Administration
Everest College - Los Angeles
Los Angeles, CA01.2009
Skills
- Process Improvement
- Operations Management
- Staff Management
- Strategic Planning
- Training and Mentoring
- Policy Enforcement
- Process Monitoring and Improvement
- Processes and Procedures
- Bilingual
Timeline
Auto Claims Supervisor
Seaharbor Insurance
12.2022 - Current
Bodily Injury Claims Adjuster
State Farm
06.2016 - 12.2022
Senior Customer Service Representative
Blue Cross Of California
01.2005 - 12.2014
Bachelor of Science - Business Administration
Everest College - Los Angeles
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