Elita Uresti
McAllen
Summary
Dynamic Senior Claims Adjuster with extensive experience , excelling in negotiation and liability assessment. Proven track record of resolving complex claims and achieving satisfactory settlements. Bilingual in Spanish, leveraging critical thinking and claims analysis to enhance service quality and client satisfaction. Committed to delivering exceptional results in high-pressure environments.
Overview
10
10
years of professional experience
Work History
Commercial GL- Claims Examiner
Sedgwick Claims Management
Blue Ash
08.2023 - Current
- Conducted thorough investigations of claim disputes through documentation and evidence collection.
- Analyzed medical records, bills, and reports to assess claims validity.
- Monitored litigation activities related to bodily injury cases, reporting findings to management.
- Maintained expertise in state-specific laws governing bodily injury claims.
- Acquired necessary information for accurate injury claim evaluations.
- Evaluated commercial claims to confirm validity and coverage under policy terms.
- Negotiated settlements with claimants or their representatives in accordance with state laws and insurance policies.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Reviewed and applied state laws and regulations to ensure compliance in claim handling.
- Resolved claim disputes through mediation and negotiation, minimizing the need for litigation.
Senior Claims Adjuster
National General Insurance Company - Remote
04.2022 - 08.2023
- Verified insurance claims and determined fair amount for settlement.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Researched and analyzed policy contracts to verify proper payment of claims.
- Prepared summaries of damage, payments, and policy coverage.
- Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
- Determined salvage value on total-loss vehicle.
- Carried and managed consistently heavy project workload through exemplary organizational, time management and collaboration talents.
- Analyzed complex data and prepared accurate and comprehensive reports for clients.
- Kept current on insurance regulations, laws, policies and procedures.
- Handled and evaluated Bodily Injury claims
- Negotiated terms and handled settlements and adjustments with attorneys, claimants and co-defenders.
- Evaluated claims to determine coverage and liability under policy guidelines.
Senior Claims Adjuster
Remote B2 claims TPA
08.2021 - 04.2022
- Examined photographs and statements.
- Interviewed claimants and witnesses to gather factual information.
- Investigated and processed insurance claims for policyholders.
- Consulted police and hospital records when needed.
- Investigated properties to determine extent of damage and estimate repair costs.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
- Handled and evaluated Bodily Injury claims - nonrep
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Resolved complex, severe exposure claims using high service oriented file handling.
- Negotiated terms and handled settlements and adjustments with attorneys, claimants and co-defenders.
- Documented and tracked claims approval process and communicated status monthly with claimants, attorneys and in-house personnel.
Bodily Injury Claims Adjuster
Insurance Claims Associates - Remote
02.2020 - 08.2021
- Negotiated terms and handled settlements and adjustments with attorneys, claimants and co-defenders.
- Evaluated coverage, liability and damages and investigated suspicious claims.
- Interviewed policyholders, witnesses and third parties to gather information and details regarding injury event.
- Conducted claims investigations by obtaining written statements, preparing reports, researching public records and conducting personal interviews.
- Prepared and presented complex cases to management, in-house legal team and Claims Committee.
- Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
- Interviewed relevant parties to determine claim denial or settlement.
- Maintained contact with claimants and attorneys to determine treatment status
- Conducted claims investigations by obtaining written statements, preparing reports, researching public records and conducting personal interviews.
Auto/Bodily Injury Claims Adjuster
Fred Loya Insurance
01.2016 - 02.2020
- Negotiated terms and handled settlements and adjustments with attorneys, claimants and co-defenders.
- Evaluated coverage, liability and damages and investigated suspicious claims.
- Interviewed policyholders, witnesses and third parties to gather information and details regarding injury event.
- Conducted claims investigations by obtaining written statements, preparing reports, researching public records and conducting personal interviews.
- Interviewed relevant parties to determine claim denial or settlement.
- Prepared summaries of damage, payments, and policy coverage.
- Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Resolved complex, severe exposure claims using high service oriented file handling.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
Education
Associate of Arts - Paralegal
South Texas College
Mcallen, TXSkills
- Productivity standards
- Service quality assurance
- Liability assessment
- Spanish fluency
- Claims analysis
- Critical thinking
- Settlement negotiation
Languages
Spanish
Native/ Bilingual
Timeline
Commercial GL- Claims Examiner
Sedgwick Claims Management
08.2023 - Current
Senior Claims Adjuster
National General Insurance Company - Remote
04.2022 - 08.2023
Senior Claims Adjuster
Remote B2 claims TPA
08.2021 - 04.2022
Bodily Injury Claims Adjuster
Insurance Claims Associates - Remote
02.2020 - 08.2021
Auto/Bodily Injury Claims Adjuster
Fred Loya Insurance
01.2016 - 02.2020
Associate of Arts - Paralegal
South Texas College