Vanessa Ann Ramirez
JP Morgan Chase
Converse,Texas
9
years of professional experience
Motivated and results-oriented professional committed to achieving organizational and project goals. Proven ability to foster teamwork, coordinate project activities, and adapt to evolving priorities while maintaining a strong focus on successful outcomes. Experienced in coordinating and managing projects, particularly through volunteer service with the American Heart Association and other nonprofit initiatives. Skilled in scheduling, budget management, team collaboration, and clear communication. Reliable, adaptable, and highly organized, with a demonstrated ability to support teams, manage competing priorities, and consistently deliver results.
Work History
Fraud Specialist
1 Year 5 Months- Resolved complex disputes through effective communication and negotiation strategies.
- Analyzed case details to determine appropriate resolutions based on company policies.
- Coordinated with cross-functional teams to streamline dispute resolution processes.
- Developed and maintained documentation for dispute cases ensuring compliance and accuracy.
- Trained junior specialists on best practices for handling disputes efficiently.
- Implemented process improvements that reduced dispute resolution timeframes significantly.
- Led initiatives to enhance customer satisfaction during conflict resolution interactions.
- Used sound judgment and available resources to make well-informed decisions for case approval or denial.
- Analyzed, researched and resolved payment claims within required timeframes.
- Adhered to department processes, procedures and goal expectations for case investigations.
- Kept up to date on industry information, system changes, network rules and compliance issues.
- Resolved disputes efficiently by conducting thorough investigations and applying appropriate resolution strategies.
- Leveraged strong communication skills when liaising between parties to facilitate clear understanding and resolution of issues at hand.
- Provided comprehensive training to new team members on dispute processes and best practices, enhancing overall team performance.
Bodily Injury-Casualty Non-Repp'd
10 Months- Reduced loss ratios through fair and prompt processing of claims.
- Obtained relevant evidence and information regarding suspicious claims.
- Interviewed claimants, medical specialists and employers to determine pertinent claim information.
- Managed a caseload of 100 files.
- Conducted interviews, gathered detailed information and completed field investigations.
- Investigated any potentially fraudulent claims with a focus on thoroughness, quality and cost control.
- Identified and collected evidence and determined its value to a specific claim.
- Conducted claim and estimate re-inspections.
- Reviewed collection files to determine next steps in the collection process.
- Recommended settlement offers and negotiated payment arrangements.
- Obtained all necessary information to complete proper evaluation of injury claims.
- Investigated claims, conducted field audits, determined losses and reported findings.
- Completed required investigations on referred files in a timely manner.
- Analyzed first reports of loss and underlying file material to determine if a claim was suspect.
- Reviewed data to verify the validity of claims.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Submitted proper documentation to benchmarking programs to determine costs of treatment, expected recovery dates, and negotiate medical costs.
- Effectively reduced medical bills in fair settlement of injury claims.
- Effectively settled injury claims in a timely manner.
- Consistently met department requirements of 30 settlements per month.
- Consistently met department requirement of maintaining 80% retention of claimants without attorney representation.
- Properly evaluated, negotiated and settled non-represented injury claims in a timely manner.
Arbitration Specialist
1 Year 10 Months- Confidently wrote contentions supporting the company’s liability and damage dispute positions while supporting contentions with viable evidence and response to arbitration hearings through inter-company arbitration in Arbitration Forums.
- Effectively answered arbitration disputes of liability and damages with a win percentage of 50% while industry standard remains 43%.
- Evaluated all evidence with the ultimate goal of creating positive outcomes for client's claims.
- Synthesized data into comprehensive quarterly written reports for management.
- Directed and coordinated various investigations conducted by field investigations team.
- Drafted investigative reports covering all phases of the investigation in each case.
- Guided and trained 1 other specialist.
- Answered questions posed by claimants, insureds, and attorneys.
- Substantiated legitimate claims and denied unjustified claims.
- Partnered with legal counsel in response to select arbitration files.
- Provided final decision in round table reviews of liability decisions for liability department.
Property Damage Adjuster
3 Years 4 Months- Thoroughly investigated auto claims by taking statements from all parties involved while reviewing damages and scene investigations.
- Determined liability through proper investigation.
- Quickly and fairly settled and closed 99% of all claims received on a monthly basis.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Evaluated all evidence with the ultimate goal of creating positive outcomes for client's claims.
- Reviewed new files to determine current status of vehicle damage and develop a plan of action.
- Answered questions posed by insured, claimants and adverse carriers.
- Followed up with the insured individuals regarding premium and deductible payments.
- Answered customer questions regarding policy coverages.
- Documented all investigation activity and presented reports to management.
- Substantiated legitimate claims while denying unjustified claims.
- Evaluated insurance policies and analyzed damages to determine coverage.
Property Damage Clerk
3 Years 4 Months- Sent status letters on claims process.
- Spoke to claimants, adverse carriers and insureds to advise on services being rendered.
- Worked side by side with claims adjusters and assisted with processes.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Answered questions posed by insured and claimants.
Education
High School Diploma - General Education
Skills
Licensed adjuster in the states of TX
NM
OK
Claims file management processes
Insurance fraud expertise
Database management
Subrogation Experience
Strong interpersonal and communication Skills
Rules of evidence
Auto claims
Self-directed
Analytical
Team player
Decisive
Critical thinker
Risk Management Experience
Valuation knowledge
Personal
Casualty and personal loss Experience
Insurance policy coverage knowledge
Accident scene investigation experience
Skilled Multi-tasker
Highly motivated
Customer service oriented
MS office knowledge
Experienced policy investigator
Data Analysis
Automobile Claims Specialist
Advanced oral and communication skills
Organized
Arbitration Experience
Timeline
Fraud Specialist
JP Morgan Chase
04.2025 - CurrentRead More
Bodily Injury-Casualty Non-Repp'd
Loya Insurance Company
06.2024 - 04.2025Read More
Arbitration Specialist
Loya Insurance Company
08.2022 - 06.2024Read More
Property Damage Adjuster
Loya Insurance Company
02.2021 - 06.2024Read More
Property Damage Clerk
Loya Insurance Company
10.2017 - 02.2021Read More
Theodore Roosevelt High School
High School Diploma from General Education
Read More