Summary
Overview
Work History
Education
Skills
Languages
Timeline
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Jonathan Mendoza

Winter Haven,Florida

Summary

Tactful Claims Specialist with expertise in settlement preparation, claims processing and appeal filing. Diplomatic and personable professional accustomed to handling sensitive, confidential information and investigating complex liability claims. Committed to maintaining customer satisfaction and contributing to company success.

Overview

6
6
years of professional experience

Work History

Bilingual Insurance Claims Specialist

GEICO Indemnity
08.2021 - Current
  • Processed and recorded new policies and claims.
  • Conducted risk evaluations on claims settlement proposals to encourage sound decision-making regarding settlement offers.
  • Provided advice to customers regarding claims, rights and insurance processes to prevent disputes.
  • Communicated verification and authorization status updates with Auto Damage department to facilitate decision-making for insurance coverage.
  • Generated, posted and attached information to claim files.
  • Followed up with customers on unresolved issues.
  • Utilized appropriate cost containment techniques to reduce overall claim costs.
  • Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
  • Collaborated with legal counsel to make organizational claims decisions aligning with governing laws.
  • Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
  • Escalated files with significant indemnity exposure to supervisor for further investigation.
  • Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
  • Conducted full claim investigations and reported updates and legal actions.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
  • Verified client information by analyzing existing evidence on file.
  • Posted payments to accounts and maintained records.
  • Evaluated and settled complex insurance claims in strict timeframes.
  • Negotiated with other involved parties to arrange settlements for maximum results.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Checked documentation for accuracy and validity on updated systems.
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Drafted and reviewed legal documents utilizing knowledge of relevant clauses to minimize incurred liability.
  • Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.
  • Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.

General Manager in Training

Hardee's Restaurant
08.2018 - 07.2021
  • Updated and resolved incidents and managed accessorial charges objectively while maximizing profit.
  • Trained and guided team members to maintain high productivity and performance metrics.
  • Implemented innovative programs to increase employee loyalty and reduce turnover.
  • Implemented business strategies, increasing revenue and effectively targeting new markets.
  • Reported issues to higher management with great detail.
  • Scheduled employees for shifts, taking into account customer traffic and employee strengths.
  • Handled problematic customers and clients to assist lower-level employees and maintain excellent customer service.
  • Managed purchasing, sales, marketing and customer account operations efficiently.
  • Assisted in recruiting, hiring and training of team members.
  • Cultivated and strengthened lasting client relationships using strong issue resolution and dynamic communication skills.
  • Trained new employees on proper protocols and customer service standards.
  • Tracked trends and suggested enhancements to both challenge and refine company's product offerings.
  • Interacted well with customers to build connections and nurture relationships.
  • Reduced financial inconsistencies while assessing and verifying billing invoices and expense reports.
  • Monitored daily cash discrepancies, inventory shrinkage and drive-off.

Overnight Stocker and Receiver

Walmart
07.2017 - 08.2018
  • Collaborated with other departments to resolve potential incoming shipment issues.
  • Collected, analyzed and modeled sales trends and customer preferences data to inform inventory development decisions.
  • Moved cardboard, plastic ties and other debris from unboxing to trash.
  • Disposed of damaged or defective items or coordinated returns to vendors for covered items.
  • Transported merchandise to sales floor and replenished out-of-stock and low-stock items.
  • Conducted counts and audits of inventories to identify and resolve discrepancies in records.
  • Maintained tidy, organized and safe work area to comply with cleanliness standards.
  • Coordinated efficient organization, palletizing and transportation of completed packages.
  • Monitored and managed stock levels of goods to verify availability of products.
  • Adhered to safety processes and procedures when stocking store to avoid falls and other injuries.
  • Stocked shelves, racks and cases with new or transferred merchandise.
  • Operated equipment such as pallet jacks and hand trucks to move heavy boxes.
  • Marked stock with identification tags and labels to outline information such as storage locations.
  • Orchestrated effective materials management with strong stock rotation strategies, new order placements and shipping inspections.
  • Maintained store assets with effective loss prevention strategies.
  • Executed regular inventory counts and supply audits to monitor shrinkage and generate insights into purchasing decisions.

Education

High School Diploma -

Lake Region High School
Eagle Lake, FL
05.2016

Licenses & Certifications

Skills

  • Data Integrity
  • Information Updates
  • Office Equipment
  • Interpretation Skills
  • Calculator Proficiency
  • Financial Transactions
  • Claim Validity Determination
  • Accounts Payable and Accounts Receivable
  • Data Collections
  • Electronic Filing System
  • Client Relationships
  • Purchase Orders

Languages

Spanish
Native or Bilingual
English
Native or Bilingual

Timeline

Bilingual Insurance Claims Specialist

GEICO Indemnity
08.2021 - Current

General Manager in Training

Hardee's Restaurant
08.2018 - 07.2021

Overnight Stocker and Receiver

Walmart
07.2017 - 08.2018

High School Diploma -

Lake Region High School

Licenses & Certifications

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Jonathan Mendoza