Brianda Garcia Pineda
Laveen
Summary
Proficient claims associate skilled in handling high volumes of claims. Processes adjustments based on identifiable liability and compensability. Supports work of senior team members by organizing documentation and assisting on complex cases.
Seasoned insurance specialist with excellent planning and problem solving abilities. Offering several years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.
Overview
9
9
years of professional experience
Work History
Insurance Claims Specialist
State Farm
Phoenix
05.2019 - Current
- Reviewed insurance claims for accuracy and compliance with policy guidelines.
- Communicated with clients to gather necessary documentation for claims processing.
- Investigated claim details by analyzing reports and interviewing relevant parties.
- Documented claim findings in the claims management system for record-keeping.
- Provided expertise in policy interpretation to support claim resolution efforts.
- Processed requests for additional documentation from customers in a timely manner.
- Assisted customers in filing new insurance claims and provided status updates on existing ones.
- Maintained detailed records of all claim activities including correspondence, decisions, payments.
- Determined liability, compensability, and benefits due on each claim.
- Negotiated settlements between claimants and insurers when necessary to resolve disputes quickly.
- Resolved customer complaints related to insurance claim processing.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
Dry Cleaner Customer Service Representative
Escalade Dry Cleaners
Phoenix
02.2017 - 05.2019
- Assisted customers with inquiries regarding dry cleaning services and pricing.
- Processed garments for cleaning, ensuring proper labeling and sorting.
- Operated cleaning machines according to safety and operational guidelines.
- Maintained cleanliness and organization of the customer service area.
- Educated customers on care instructions for various fabric types.
- Greeted customers and provided excellent customer service.
Education
Mountain Pointe High School
Ahwatukee , AZSkills
- Policy interpretation
- Risk assessment
- Documentation management
- Claims processing
Affiliations
- I’m creative, I do many crafts whether it be digital or physical.
Timeline
Insurance Claims Specialist
State Farm
05.2019 - Current
Dry Cleaner Customer Service Representative
Escalade Dry Cleaners
02.2017 - 05.2019
Mountain Pointe High School