1. JenifferVale C.A.
cellular704-303-1321
871 IbisWalkPlace N.SaintPete ,FL 33716
jeniffervale@yahoo.com
RESUME
PROFESSIONAL SUMMARY
Highlydedicatedandconscientious ClaimsManager&Specialistwithaprovenrecordof highclient
satisfaction.Experiencedinobtainingoptimal legaloutcomesforlegitimate claimsacrossawide variety
of industries. Bilingualinadditontocarryingvastknowledge inanarrayof industry-specificoptions for
individualclaimscases.
CORE QUALIFICATIONS
 ALL-LINES ADJUSTER LICENSE (6-20), State of Florida (Reciprocal – IN, TX, Carolinas)
 Adept at interacting and maintaining relationships with government entities such as EPA for
HAZMAT claims processing.
 Excellent facility with HAZMAT (Hazardous Materials) terminology
 Experienced in handling confidential information
 ExperiencedinProcessImprovementandTrainingStaff atall levels
 Expert level handling of Claims Escalations through to Resolution
 Extensive workers' compensation claim management experience
 Outstanding written and oral communication skills
 Proven track record for delegated assignment of high dollar liability and adjudicated claims
 Strong history of building working relationships with trust and integrity
 Sound analytical and computer skills
 Spanish Language Trainer for Navy SEALs, U.S. Navy primary special operations force and
Command maintaining military contract for 4 years with Berlitz School of language.
 WorkersCompensation(MedOnly& LossTime),Auto(PIP &MedPay), AttorneyDemands,
Reserve Management,SIU,LiabilityClaims,PropertyClaims,Social NetworkInvestigations.
CLAIMS MANAGEMENTSYSTEMS
 Advancer- Medical ClaimsManagement
 ClaimsWire Dashboard
 Diamond(web) ClaimsSystem - Insuresoft
 Facts ClaimsPre-processingSystem - Ebix Software
 FileTrac™ ClaimsManagementSystem
 Guidewire ClaimCenter
 IDX - Groupcast Financial ManagementSystemforSmall ProviderGroups
 Mitchell WorkCenter™ - CollisionClaimsManagementSoftware
 QNXTWorkflow™ forClaimsAdjudication - TriZettoSoftware
 SurePowerInnovationClaimsmanagement
 Xactimate version28 Professional

2. EXPERIENCE
March 10th
, 2016 through September9th
, 2016
ClearPointClaims,Charlotte,NC
Inside PropertyAdjuster
 Monitoredandsupervisedall assignedfieldadjusteractivitiesandupdatesthroughFileTrac™
ClaimsManagementSystem,handlingclaimsintimelyfashion.
 Made necessaryadjustmentstosubmitted‘FieldAdjuster’estimates(ESXFiles) through
Xactimate 28 inorderto meetcarrierspecificrequirements.
 HandledHO-3(aka Homeowners3,Special Form) claimsforvariousnational carriersasassigned
until file closure. (Boulder,BoulderICAT,TFPA,TWIA,BANKERS,ARGO,GAI,PENNYMAC)
 EnteredFirstNotice of Loss(FNOL) forvariousnational carriersandhandledSpanishSpeaking
Insureds.
 Ensuredclaimbundlescontainedall necessaryinformationwhichwascarrierspecificaswell as
containingthe final invoicesandXactimate ESXFiles.
 EditedFieldAdjusterreportstomeetcarrierspecificstandards.
April 20th
, 2015 through December30th
, 2015
PeterJ Crosa& Co.,St. Petersburg,FL
Bilingual WorkersComp Claimsmanager&SeniorAdjuster
(8 month Temporary Contract)
 Adjustedandmanagedclaims investigationsforGeneral Liability - All LinesInsurance and
WorkersComp.
 Attendedindustryeventsandconferencesascompanyrepresentative.
 Conducteddetailedfieldinvestigationsforpremiumliabilityandadjudicatedclaims
 Createdandmonitoredcompanysocial mediaaccounts.
 Createdmarketingmaterialsandmanagednew businessstrategies.
 Identified,developedandmaintainedrelationshipswithnew andexistingclientsinorderto
generate andmaintainnewbusiness.
 Managed adjustersandadministrative staff.
 Met withclaimsmanagersfromvariouscompaniesweekly.
 Prepareddetailedaccidentscene documentation,photography,inadditiontorecordedand
writtenstatements.
December2014 through February 2015
Integral QualityCare
Team projectManager(Assignment-LimitedProject- AppleOne)
(3 monthTemporary Contract)
 Communicateddailywithuppermanagementtoaddressall openissues,andfollowupon
reportsand trends.
 Ensuredteamhad accessto all resourcesandprograms requiredtocomplete assignedtasks.
 Keptaccurate recordsof projectprogressusingMS Excel withprojectspecifictemplates.
 Ledteam of claimspecialistsindailyprojectoperationsbringingthe companybackup to
compliance withCMSguidelineswithin3weeksof projectstartdate
 Providedcoachingwhenappropriateinordertoensure qualityandtimelineswere met
accurately.
 Providedencouragementandmotivationtoteambycelebratingandrecognizingtheirindividual
successes.

3.  Supportedteambyconductingdailymeetingsforqualityandprojectdevelopment.
 Troubleshootedissuesonthe floorprovidingfollow upandcoachingwhenitwasappropriate.
July 8th
, 2014 through December5th
2014
MetLife
Settlementadjuster(Assignment-LimitedProject- AppleOne)
(5 month Temporary Contract)
MetLife Group,Voluntary&Worksite Benefits - P&CClaims|No Fault| Tampa FCO
 AssistedPIPdepartmentwithadditionalprojectsasassignedbymanagement.
 Communicateddailywithmanagementandparticipatedin weeklyprojectconference call
meetingswithboardmembers.
 Made dailypaymentsthroughrestrictedLinux basedprogramtoprovidersonce amountof final
payoutswere determinedinordertosatisfysettlementorder.
 PerformeddailyPIPclaimsintake andfile monitoring.
 Processedall incomingAttorneyDemands.
 Responsible forassessingpaymentstoprovidersparticipatinginclassactionlawsuitthrough
analyzingPIP(personal insurance protection) andMed-Paypaymentlogs.
 Reviewedentireproviderbillinghistoryincludingmedicalssubmittedinordertoaccurately
determine if paid-at-fee scheduleandwhatbalance wascurrentlyrequiredtomeetsettlement
guidelines.
 Special Project‘Leadadjuster’forMetLife classactionlawsuit,Losssettlement
 Successfullytrackedprojectprogressandinformationbyutilizingexcel templatesmaking
informationaccessibletoall projectparticipants.
 Recognizedbymanagementatendof contract forexcellentqualityof work.
April 2013 through May 5th
, 2014
Aetna,TampaFL
SeniorWCClaimsAdministrator
 Actedas primarytrainingsupporttoAgentswhile class wasintransition.
 Communicatedwithmanagementteamtomaintainproduct/service knowledgebaseand
ascertainmentof additional trainingneeds.
 Documentedperformanceof Agentsintrainingandmade recommendationstoadvance,
terminate orrequire additional training.
 Ledclientcalibrationsessionstoensure alignmentof trainingwithclientmetrics.Maintained
recordsof all trainingactivities, includingtime sheets,evaluationsandqualityreviews.
 Monitoredandanalyzedongoingperformance trendsinordertomake trainingand
developmentrecommendations.
 Providedcorrective and/orpositive performance feedbackasapplicable.
 Supervised,evaluatedandcoachedemployeeswhiledeliveringtraining.

4. August 23rd
, 2010 throughto April 2013 merger (Aetna)
CoventryHealthCare,Inc. , Tampa FL
SME/Training LiaisonWC claims
 Activelycommunicatedwithprovidersbothnationallyandlocally inordertogathermissing
informationtoprocessandcomplete anyWCrequestsforclaimants.
 Assistedstaff andnewhireswithquestionspertainingtoclaimsreceivedonthe floor.
 Managed webbasedsystemsformajorTPA'sfor UR review todeterminemedical necessity.
 OrganizedandcreatedQA checklistforPAR(PriorAuthorizationRequest) forms.
 Processedall assigned‘escalatedproviderandadjuster’pre authorizationrequeststhrough
variousprograms
 Provided‘systemsoperations’and‘workflowprocess’ trainingfornew hiresandexistingstaff
movingtonewaccounts.
 WorkedwithAdjustersfromvariousnationalcarriersinansweringquestionspertainingtoany
followupsrequiredregardingescalatedclaims.
EDUCATION
June 2015
AdjusterPro,LLC. (Orlando,FL)
CertifiedAdjuster,All linesFLResidentIndependentAdjuster6-20License
September1999 through June 2002
Universityof PuertoRico,RíoPiedrasCampus
ESL Core Certification - FluencyinSpanishandEnglish
Summer 1998
NYU – (Summer) Course workinEnglishComposition.
January 1993 through June 1997
ColegioLaPiedad - San Juan,PuertoRico
AcademicDiploma,3.6GPA
Recipientof "Medallade Oro"forcompletingdual historymajorinone semesteryear.