Trina Pacheco
Intercare Holdings Insurance
Pomona,CA
7
Years of experience
Dynamic Claims Adjuster with a California license and proven expertise in negotiating settlements and managing high caseloads. Recognized for exceptional customer service and critical thinking, successfully reducing claim turnaround time while fostering positive client relationships. Highly motivated to deliver effective solutions in fast-paced environments.
Work History
Claims Adjuster
7 Years 4 Months- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers.
- Maintained detailed records of claims activities, ensuring data accuracy and timely reporting.
- Resolved escalated client issues, providing effective solutions while maintaining positive relationships.
- Able to maintain a large caseload, while prioritizing monthly closures.
- Maintain thorough records of all claims activities, including interactions, decisions, and outcomes, to ensure accurate processing and compliance with audits.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Provided exceptional customer service, addressing concerns and resolving issues promptly.
Claims Adjuster
6 Years 5 Months- Supported management in audits by providing detailed reports on claims processed within specified timelines.
- Prepared files, letters and notices.
- Completed Expedited Medical Referrals/Documentation in timely manner.
- Scheduled medical appointments and claims depositions.
- Followed up with customers on unresolved issues.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Assisted in training new team members on claims processing procedures and best practices.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Posted payments to accounts and maintained records.
- Investigated claims files to determine coverage, liability, and compensability.
- Communicated with claimants, insureds, and providers to gather essential case information.
- Calculated reserves and updated claim notes in claims management systems.
- Negotiated settlements while maintaining compliance with policy terms and regulatory requirements.
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Achieved high customer satisfaction ratings by providing clear and timely communication throughout the claims process.
Education
GED
Skills
Critical thinking
Claims investigation
Highly motivated
Settlement negotiation
Decision-making
Caseload management
Customer service
Problem-solving
Multitasking and organization
Empathy and patience
California claims adjuster license
Accomplishments
- SIP certified on May 14, 2025
- Received a Certificate for Appreciation for receiving compliments from multiple claimants with on month.
Timeline
Claims Adjuster
Intercare Holdings Insurance
07.2019 - CurrentRead More
Claims Adjuster
Sedgwick
07.2019 - 12.2025Read More
Gardena Adult School
GED
Read More