Veronica Hernandez
East Los Angeles
Overview
25
25
years of professional experience
Work History
Claims Examiner II
Interinsurance Exchange Of Southern California
11.2017 - 03.2022
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Examined photographs and statements.
- Negotiated settlements with claimants'' attorneys when needed, achieving favorable outcomes for both parties while minimizing costs.
- Conducted thorough investigations of complex claims, gathering relevant documentation and interviewing witnesses when necessary.
- Consulted police and hospital records when needed.
- Assisted in the development of training materials for new Claims Examiners, fostering a supportive learning environment.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Maintained contact with claimants and attorneys to determine treatment status.
Bodily Injury Claims Adjuster
Access General Insurance
02.2011 - 10.2017
- Participated in ongoing training programs to stay up-to-date on industry trends, regulatory changes, and best practices for bodily injury claims handling.
- Negotiated terms and handled settlements and adjustments with attorneys, claimants and co-defenders.
- Prepared and presented complex cases to management, in-house legal team and Claims Committee.
- Interviewed policyholders, witnesses and third parties to gather information and details regarding injury event.
Material Damage Claims Adjuster
21st Century Insurance/Farmers Insurance Company
12.1996 - 12.2010
- Developed strong relationships with vendors and service providers, fostering trust and cooperation in the claims process.
- Identified subrogation opportunities through careful analysis of accident details, recovering funds for the company when appropriate.
- Effectively documented all communications related to claims handling for easy reference in future situations or disputes that may arise later on.
- Continuously improved professional expertise by attending training sessions and staying current on industry trends.
- Negotiated fair settlements with claimants by leveraging strong communication skills and industry knowledge.
- Maintained compliance with state regulations and company policies during the claims handling process.
Education
High School Diploma -
Sierra Vista High School
Baldwin Park, CA06.1990
Skills
- Verbal Communication
- Claims Processing
- Claims Evaluation
- Decision-Making
- Insurance policy coverage knowledge
- Accident scene investigations
- Valuation knowledge
- Settlement Negotiation
Languages
Spanish
Native or Bilingual
Timeline
Claims Examiner II
Interinsurance Exchange Of Southern California
11.2017 - 03.2022
Bodily Injury Claims Adjuster
Access General Insurance
02.2011 - 10.2017
Material Damage Claims Adjuster
21st Century Insurance/Farmers Insurance Company
12.1996 - 12.2010
High School Diploma -
Sierra Vista High School
Similar Profiles
Amanda GarciaAmanda Garcia
Universal Insurance Agent at Interinsurance Exchange of Southern CAUniversal Insurance Agent at Interinsurance Exchange of Southern CA
Jeffrey StilesJeffrey Stiles
<ul><li>Company Overview: Loggerhead is a premier Florida property insurer that offers a user-friendly process, transparent claim handling, and prompt solutions for policyholders, creating a world-class customer experience.</li><li>Responsible for creating, directing, and managing the Customer Service, Internal Sales, and Agency Support functions for a new Homeowners' Insurance Company in Florida by overseeing the short and long-term strategies of the organization's customer success journey. This may include, but is not limited to, providing strategic recommendations regarding concepts and routines that drive efficiency and empower employees.</li><li>Work closely with the CEO and COO on all aspects of delivering service to customers and agents.</li><li>Provide strategic oversight and guidance to the operational leadership team.</li><li>Work closely with other department heads to support projects or procedures that have a direct impact on customers.</li><li>Responsible for the selection and implementation of the CSAT platform as well as the Customer Relationship Management (CRM) software currently in use with the organization.</li><li>Responsible for building out all operational teams, including job development, standard operating procedures, quality management, and the like.</li><li>Work in an integrated fashion with third-party vendors to provide "world-class" customer service to Policyholders, Agents, and other customers both in and out of inbound and outbound settings.</li><li>Collaborate with business units throughout the organization to design, develop, and implement consumer-focused business practices, procedures, and Corporate Policies.</li></ul> at Loggerhead Reciprocal Interinsurance Exchange<ul><li>Company Overview: Loggerhead is a premier Florida property insurer that offers a user-friendly process, transparent claim handling, and prompt solutions for policyholders, creating a world-class customer experience.</li><li>Responsible for creating, directing, and managing the Customer Service, Internal Sales, and Agency Support functions for a new Homeowners' Insurance Company in Florida by overseeing the short and long-term strategies of the organization's customer success journey. This may include, but is not limited to, providing strategic recommendations regarding concepts and routines that drive efficiency and empower employees.</li><li>Work closely with the CEO and COO on all aspects of delivering service to customers and agents.</li><li>Provide strategic oversight and guidance to the operational leadership team.</li><li>Work closely with other department heads to support projects or procedures that have a direct impact on customers.</li><li>Responsible for the selection and implementation of the CSAT platform as well as the Customer Relationship Management (CRM) software currently in use with the organization.</li><li>Responsible for building out all operational teams, including job development, standard operating procedures, quality management, and the like.</li><li>Work in an integrated fashion with third-party vendors to provide "world-class" customer service to Policyholders, Agents, and other customers both in and out of inbound and outbound settings.</li><li>Collaborate with business units throughout the organization to design, develop, and implement consumer-focused business practices, procedures, and Corporate Policies.</li></ul> at Loggerhead Reciprocal Interinsurance Exchange
ALONDRA MONTALVOALONDRA MONTALVO
Prime Claims Adjuster at Interinsurance Exchange of the Automobile ClubPrime Claims Adjuster at Interinsurance Exchange of the Automobile Club
Alexis GalvanAlexis Galvan
Customer Service Representative at Flyer High School Teen JobsCustomer Service Representative at Flyer High School Teen Jobs
Citlali Felix-MartinezCitlali Felix-Martinez
Sales Floor Associate at Bath & Body WorksSales Floor Associate at Bath & Body Works