Summary
Overview
Work History
Education
Skills
Timeline
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Shayleen Naico

SIERRA VISTA,AZ

Summary

I am a highly motivated Senior Claims Adjuster committed to diligently investigating, evaluating and negotiating claims with the seller and contract holders' best interest in mind. Adept at training and supporting new adjusters, am trained and knowledgeable in state, federal and local laws, and skilled in recognizing potential fraudulent claims. Highly detail-oriented, and dedicated to improving efficiency, productivity and profitability through continuous process improvement.

Overview

18
18
years of professional experience

Work History

Senior Claim Adjuster

EFG Companies
10.2014 - Current
  • Provides day-to-day guidance to Claims Adjusters and Customer Service Representatives by monitoring their claim activity and responding to questions from the repair facilities or customers.
  • Performs diagnosis and investigation of unusual claims, as needed, by talking to repair facilities, customers, or any other involved parties.
  • Reviews all technical issues for accuracy of diagnosis, repairs, and proper procedures.
  • Performs claims reviews and conducts coaching for Claims Adjusters and Customer Service Representatives in regular intervals including, but not limited to, metrics and behaviors related to the customer experience.
  • Serves as liaison to other departments; establishes and maintains working relationships necessary to develop cooperation and collaboration across the organization.
  • Assists in handling of customer escalations.
  • Assists in routing and monitoring of the call queues so that the department meets is ASA and Abandon call metric goals.
  • Keeps abreast of all new EFG products for proper administration and handling.

Report Reviewer

Southwest Auto Inspections
02.2009 - 10.2014
  • Maintained strong attention to detail while reviewing inspection reports, ensuring consistent quality and accuracy.
  • Mentored junior reviewers, sharing best practices and guiding their professional growth within organization.
  • Reduced turnaround time for reviews by effectively prioritizing tasks and managing deadlines.
  • Ensured consistency across multiple review projects by maintaining strict adherence to established protocols and procedures.

Claims Adjuster

EFG Companies
11.2005 - 02.2009
  • Claims detail including gathering of Labor time and cost, parts costs, match parts and labor to appropriate guide for accuracy, enter information into system including all part numbers, tax, sublets, and shop supplies,
  • Set-up claims in system with notes, reasons for approval/denial and provide authorization number.
  • Order inspections from independent inspection companies while being conscious of cost for all areas of claims administration.
  • Review inspections for proper diagnosis and determine proper claims coverage.
  • Purchase outside parts, when necessary, in order to keep claims cost in line.
  • Knowledgeable of all new EFG products for proper administration and handling.
  • Review all technical issues for accuracy of diagnosis, repairs, and proper repair procedures.
  • Perform investigation of unusual claims as requested by management by talking to customers, repair facilities, or any other involved parties.
  • Perform other duties, as assigned.

Education

High School Diploma -

Buena High School
Sierra Vista
06.1986

Skills

  • Claims Processing
  • Professionalism and Integrity
  • Team Leadership Qualities
  • Computer Software Proficiency
  • Attention to Detail Focus
  • Strategic Decision-Making
  • Time management mastery
  • Analytical Problem Solving
  • Regulatory Compliance Knowledge
  • Conflict resolution techniques
  • Claims files management processes
  • Fraud Detection Proficiency

Timeline

Senior Claim Adjuster

EFG Companies
10.2014 - Current

Report Reviewer

Southwest Auto Inspections
02.2009 - 10.2014

Claims Adjuster

EFG Companies
11.2005 - 02.2009

High School Diploma -

Buena High School

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Shayleen Naico