Wilfredo Garcia
Hialeah,Florida
Summary
Targeted a position within the company to apply skills and expertise, driving superior performance and value.
Achieved high levels of customer satisfaction through effective management of sales and service teams. Drove operational success in multi-million-dollar REIT and communication sectors by leveraging strong interpersonal skills. Fostered a collaborative environment that promoted quick learning and adaptation to complex challenges.
Overview
9
9
years of professional experience
2
2
years of post-secondary education
Work History
Field Claims Adjuster- Auto Damage
Progressive Insurance
09.2022 - Current
- Complete 4 or more vehicle inspections, write estimates, determine total loss evaluations, and set clear expectations and timelines
- Negotiate repair process with body shops
- Document information related to the claim and make decisions consistent with claims standards and local laws
- Evaluate and handle claim payments and resolution of claims without payments
- Review and determine validity of any supplement requests
Resolution Associate Level II/Trainee
Gallagher Bassett, LLC
12.2021 - 09.2022
- Learn to investigate claims with overall instruction, exposure, and preparation
- Analyze and evaluate up to 35 claims to make appropriate decisions and recommendations
- Effectively communicate with clients and contacts
- Interacts extensively with various parties involved in the claim process
- Processes claims consistent with clients’ and corporate policies, procedures and best practices and also in accordance with any statutory, regulatory and ethics requirements
Assistant Trainer/Patient Services Coordinator
Cora Physical Therapy
11.2019 - 11.2021
- Supervised, taught and mentored 20 others on the duties of the Patient Services Coordinator position
Assists PSC Regional Trainer with interviewing and hiring of PSCs as needed
Spearheaded appearance, function and cleanliness of therapy and office space
Instruct patients on the completion of new patient forms, as per the billing manual, and advise patients of their financial responsibility (i.e..,copay/deductible amounts per visit and expectation of receiving such at each visit)
Verify all patient insurance for therapy benefits, co-payments, limitations, approved of visits, expiration dates for authorizations, etc..
Screened all incoming calls promptly and politely and took/relay messages as necessary
Senior Grievance & Appeals Analyst/Auditor
HealthSun Health Plans
01.2017 - 02.2019
- Prepare up to 50 audit findings and recommendations for Appeal Analysts and management monthly
Evaluate urgency of clinical situation to assess appropriate handling, determine if sufficient records were obtained, and review medical records and medical policies to determine if correct criterion has been utilized in each review
Assists management in process improvement strategies to achieve business objectives
Review case documentation to assess appropriate system entries have been made and that the step-by-step process is sufficient to mitigate risk associated with regulatory reviews, and potential litigation
Ensure compliance of all OSHA, HIPAA as well federal, state and local regulations as well as all company policies and procedures
Education
Paramedic Certification -
Broward Community College
08.2001 - 05.2003
PCA Professional Claims Adjuster -
Central Insurance School
03.2019
CPSR Certified Professional Service Representative -
Central Insurance School
03.2019
Skills
Liability analysis
Coverage verification
Claims investigation
Estimating repair costs
Education Professional Designations
- PCA Professional Claims Adjuster, 2019-03-01
- CPSR Certified Professional Service Representative, 2019-03-01
- Paramedic Certification, 2003-05-01, Broward Community College
Languages
Spanish
Native or Bilingual
English
Full Professional
Timeline
Field Claims Adjuster- Auto Damage
Progressive Insurance
09.2022 - Current
Resolution Associate Level II/Trainee
Gallagher Bassett, LLC
12.2021 - 09.2022
Assistant Trainer/Patient Services Coordinator
Cora Physical Therapy
11.2019 - 11.2021
Senior Grievance & Appeals Analyst/Auditor
HealthSun Health Plans
01.2017 - 02.2019
Paramedic Certification -
Broward Community College
08.2001 - 05.2003
CPSR Certified Professional Service Representative -
Central Insurance School
PCA Professional Claims Adjuster -
Central Insurance School