Selena Montalvo
West Palm Beach
Summary
Experienced Senior Claims Adjuster skilled in investigating and resolving complex automobile claims. Proficient in assessing coverage, liability, and damages in challenging loss scenarios. Delivers fair outcomes while enhancing process efficiency and ensuring compliance with regulatory standards. Bilingual in Spanish, facilitating effective communication with diverse clients.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Sr Claims Adjuster
Progressive
West Palm Beach/Hybrid
02.2023 - Current
- Independently investigate complex automobile claims involving coverage, liability, and damages, exercising full discretion within authority limits.
- Apply advanced understanding of insurance policies, identifying applicable coverage and exclusions.
- Manage a high-volume caseload while maintaining exceptional documentation and timely resolutions.
- Evaluate and negotiate moderate to advanced injury claims, ensuring fair, cost-effective outcomes.
- Coordinate with appraisers, repair facilities, and insureds to verify loss details and assess repair or total loss valuations.
- Identify subrogation opportunities and potential fraud indicators; collaborate with specialized units for follow-up.
- Deliver empathetic, effective communication to claimants while maintaining the company’s integrity and customer focus.
- Conducted detailed investigations into multi-vehicle and property damage claims.
- Determined liability and negotiated settlements using sound judgment and adhering to internal standards.
- Recognized and analyzed vehicle structures and body parts for accurate damage assessment.
- Worked across departments to enhance claim workflow and improve cycle time metrics.
Family Service Specialist
Early Learning Coalition of Broward County
Remote
11.2020 - 02.2023
- Determine and verify family eligibility for SR and VPK programs in accordance with state and federal guidelines.
- Conducted intake interviews to identify family needs and determine eligibility based on income and employment or educational requirements.
- Maintain accurate and confidential family records in compliance with Florida Department of Education (DOE) and Office of Early Learning (OEL) standards.
- Assisted parents in selecting childcare providers and connected families with appropriate community resources to meet their needs.
- Responded to parent inquiries, clarified program requirements, and advocated for families to ensure access to services.
- Complete documentation for funding, redeterminations, and program transfers within required timeframes.
- Collaborate with other departments and agencies to resolve childcare challenges and ensure continuity of care.
- Participate in outreach and enrollment events to inform families about early learning opportunities.
- Uphold program integrity by adhering to ELC policies, confidentiality agreements, and audit procedures.
Case Worker
Department of Children and Family Services
Remote
02.2019 - 11.2020
- Conduct interviews with applicants in person, by phone, or via online platforms to gather and verify eligibility information.
- Review and process applications, changes, and recertifications for public assistance programs (SNAP/TANF/Medicaid).
- Evaluate household income, resources, and expenses using established DCF policies and federal guidelines.
- Request, verify, and document information such as identification, income, employment status, and residency.
- Enter data accurately into the DCF Eligibility System (ACCESS Florida) and maintain complete, confidential records.
- Explain program requirements, rights, responsibilities, and appeal processes to clients clearly and compassionately.
- Identify potential fraud or intentional program violations and refer suspicious cases to the Office of Public Assistance Fraud (OPAF).
- Manage a steady caseload while meeting performance metrics for timeliness, accuracy, and customer satisfaction.
- Collaborate with community resources and agencies to assist clients in achieving self-sufficiency.
- Stay current with policy updates, training, and procedural changes affecting assistance programs.
Call Center Representative
Early Learning Coalition Of Palm Beach County
West Palm Beach/Remote
04.2018 - 02.2019
- Answer high-volume inbound calls and emails from parents, guardians, and childcare providers in a professional and courteous manner.
- Provide accurate information regarding SR, VPK, and related early learning services, eligibility, and enrollment procedures.
- Assist families in completing online applications and document submissions through the state’s Family Portal (ELC Provider Portal / OEL System).
- Verify basic eligibility information and refer families to the appropriate internal department or specialist for follow-up.
- Update and maintain client records in the Coalition’s data systems (e.g., EFS Mod, CRM, or internal case management software).
- Educate parents about resources for early childhood development, child care referrals, and community-based support programs.
- Escalate complex issues or policy-related questions to the appropriate supervisor or case management team.
- Maintain confidentiality and adhere to all Coalition, state, and federal privacy guidelines.
- Participate in ongoing training to remain knowledgeable about program policies, systems, and customer service best practices.
Front Desk Receptionist/Call Center Representative
Pediatric Associates
Wellington
02.2016 - 04.2018
- Greet patients and families promptly, courteously, and professionally upon arrival.
- Answer inbound calls, manage appointment scheduling, cancellations, and follow-up reminders.
- Verify and update patient demographics, insurance information, and required documentation in the electronic health record (EHR) system.
- Collect co-pays and outstanding balances, and post payments accurately.
- Coordinate with clinical staff to ensure efficient patient flow and communication.
- Provide information about office policies, services, and after-hours care options.
- Handled high call volumes with empathy and attention to detail, including triaging calls to the appropriate departments.
- Maintain confidentiality in compliance with HIPAA regulations.
- Participate in front office quality improvement and customer service initiatives.
- Perform additional administrative tasks as assigned (e.g., faxing, scanning, processing referrals).
Asset Protection Supervisor
Walmart
Boynton Beach
11.2010 - 02.2016
- Supervise, train, and develop Asset Protection associates to ensure consistent performance and adherence to company policies.
- Monitor store operations for potential shrink risks and implement preventive measures to minimize loss.
- Lead internal and external theft investigations in coordination with law enforcement when appropriate.
- Maintain and review store security systems, CCTV footage, and alarm protocols to ensure functionality and compliance.
- Conduct regular audits and safety inspections to verify compliance with safety, health, and security standards.
- Collaborate with store management to identify operational deficiencies and implement corrective actions.
- Ensure compliance with local, state, and federal regulations, as well as Walmart’s Asset Protection procedures.
- Review incident reports, analyze loss trends, and prepare documentation on findings for management review.
- Promote and model a culture of honesty, integrity, and respect among associates and within the store environment.
- Respond to emergencies and provide leadership during safety or security incidents.
Education
Associate of Science -
Palm Beach State College
Lake Worth, FL08-2024
Skills
- Advanced Auto Claims Investigation
- Coverage & Liability Evaluation
- Claim Resolution & Case Management
- Negotiations & Settlements
- Subrogation & Fraud Identification
- Policy Interpretation & Application
- Documentation Accuracy & Compliance
- Customer Service & Partner Relations
Certification
- Active Auto Claims Adjuster License
Timeline
Sr Claims Adjuster
Progressive
02.2023 - Current
Family Service Specialist
Early Learning Coalition of Broward County
11.2020 - 02.2023
Case Worker
Department of Children and Family Services
02.2019 - 11.2020
Call Center Representative
Early Learning Coalition Of Palm Beach County
04.2018 - 02.2019
Front Desk Receptionist/Call Center Representative
Pediatric Associates
02.2016 - 04.2018
Asset Protection Supervisor
Walmart
11.2010 - 02.2016
Associate of Science -
Palm Beach State College