Yvette De La Morena
Winter Garden
Summary
Insurance Professional with demonstrated command in Claims Resolution, specifically Professional Liability.
Overview
1
1
Certification
20
20
years of professional experience
Work History
Claims Analyst
MagMutual
Atlanta
10.2025 - Current
- Reviewed insurance policies to determine coverage eligibility.
- Collaborated with medical professionals for accurate claim assessments.
- Communicated with clients to gather necessary documentation and information.
- Resolved disputes by investigating claims thoroughly and fairly.
- Negotiated settlements with claimants and attorneys, achieving timely resolution of claims.
- Prepared detailed reports for management regarding claim adjustments.
- Investigated claim and settlement deals and reviewed coverage determinations.
- Facilitated meetings with internal departments and external vendors to resolve disputed claims.
- Provided guidance to customers regarding their rights and obligations under policy terms.
- Formulated strategies for effectively resolving complex claims issues.
- Supported policyholders through the claims process, providing exceptional customer service.
- Collaborated with underwriting teams to suggest policy adjustments based on claims trends.
CLAIMS CONSULTANT
THE MEDICAL PROTECTIVE COMPANY
05.2023 - Current
SENIOR CLAIMS SPECIALIST
NORCAL/PROASSURANCE
06.2020 - 05.2023
- Confirm coverage and manage professional liability claims and suits brought against policyholders
- Confirm coverage and resolve coverage issues in collaboration with Claims Management.
- Identified and engaged appropriate legal counsel for case representation.
- Evaluate liability and damage information to establish consistent and appropriate indemnity and ALAE reserves
- Select legal counsel
- Manage the litigation with outside counsel
- Manage litigation costs, both fees and expenses
- Provide service to insureds, assist where possible in sales and retention efforts of salesforce
- Managed cases across various venues including Florida, North Carolina, South Carolina, Texas, Oklahoma, Arkansas, New Mexico, and Puerto Rico.
- Monitor trial activities and negotiate settlements within given authority, including direct negotiation with plaintiffs and plaintiff attorneys.
- Attends trial-related activities including, but not limited to, arbitrations, mediations, settlement conferences, pre-trial conferences and trials as appropriate.
- Provide service to insureds, assist where possible in sales and retention efforts of sales force
- Monitored trial activities and negotiated settlements within given authority, directly engaging with plaintiffs and plaintiff attorneys.
- Perform other activities required of a front line claims person
- Attended trial-related activities, including arbitrations, mediations, settlement conferences, and pre-trial conferences.
- Participated in committees to enhance claims processes.
RISK MANAGEMENT SPECIALIST
HOLIDAY RETIREMENT
01.2020 - 05.2020
- Conducted intake of general liability and property-damage incidents and claims.
- Investigated, evaluated, monitored, and managed incidents and claims, conducting interviews with injured parties, witnesses, and family members to gather comprehensive information.
- Set and monitored reserves for claims to align with company policies and financial strategies.
- Attend depositions, hearings, mediations, and settlement conferences.
- Set and monitor reserves for claims.
- Engage in periodic claims review meetings.
- Conducted intake of general liability and property-damage incidents and claims to ensure accurate reporting and documentation.
CLAIMS PROCESSING MANAGER
HEALTHCARE UNDERWRITERS GROUP
01.2007 - 05.2019
- Determine /verify applicable coverage.
- Analyzed and summarized claims and lawsuits to support decision-making.
- Negotiate cases
- Strategize with defense counsel.
- Examined medical records for accuracy and relevance.
- Organize, coordinate and present cases to the claims committee.
- Reviewed case file reserves for adequacy in indemnity and ALAE, ensuring compliance with company standards.
- Review correspondence and communications relating to assigned claims activities.
- Review and approve submitted ALAE on assigned cases for all states.
- Conference with insureds to review care and treatment rendered.
- Organized and presented cases to the claims committee, facilitating informed discussions and resolutions.
Education
BACHELOR OF SCIENCE - BUSINESS PROFESSIONAL MANAGEMENT
NOVA SOUTHEASTERN UNIVERSITY
DAVIE, FLMBA -
DEVRY KELLER SCHOOL OF MANAGEMENT
MIRAMAR, FLSkills
- MS Office
- Litigation
- Claims review
- Claims analysis
- Coverage assessments
- Coverage verification
- Settlement determinations
- Accident investigations
- Regulatory compliance
Certification
Claims All Lines (620- Adjuster License)
Timeline
Claims Analyst
MagMutual
10.2025 - Current
CLAIMS CONSULTANT
THE MEDICAL PROTECTIVE COMPANY
05.2023 - Current
SENIOR CLAIMS SPECIALIST
NORCAL/PROASSURANCE
06.2020 - 05.2023
RISK MANAGEMENT SPECIALIST
HOLIDAY RETIREMENT
01.2020 - 05.2020
CLAIMS PROCESSING MANAGER
HEALTHCARE UNDERWRITERS GROUP
01.2007 - 05.2019
BACHELOR OF SCIENCE - BUSINESS PROFESSIONAL MANAGEMENT
NOVA SOUTHEASTERN UNIVERSITY
MBA -
DEVRY KELLER SCHOOL OF MANAGEMENT