GINALY ROCHA
Montgomery
Summary
Knowledgeable and dedicated bilingual workers compensation claims specialist with several years of experience in corporate insurance claims. Strong command of conflict resolution and negotiation skills combined with excellent reporting and research. Skilled in investigating and analyzing liability and compensability. Solid team player and motivated to succeed.
Overview
5
5
years of professional experience
Work History
Claim Specialist
CNA Insurance
11.2023 - Current
- Manage high complexity claims including, but not limited to, conducting thorough investigations to determine compensability and address validity concerns
- Collaborate with private investigators and staff counsel to prepare evidence, witness statements, and other documentation to prepare cases for trial.
- Deliver exceptional customer service to policyholders by addressing their concerns and providing a plan of action
Claim Case Manager
Travelers Insurance
09.2019 - 11.2023
- Handle moderate to high complexity claims and conduct investigations, including, but not limited to assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability
- Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources where appropriate.
- Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation).
Education
Associate of Arts -
Waubonsee Community College
Sugar Grove, IL05.2018
Skills
- Bilingual (Fluent in English and Spanish)
- Ability to work under pressure and problem solve
- Excellent customer service and communication skills
- Ambitious and motivated to succeed
- Capable of analyzing and solving problems in a timely manner
- Leadership skills
- Attention to detail
- Strong organizational and time management skills
- Proficiency in Microsoft Office Suite
Volunteer
Aurora Puerto Rican Cultural Council
Scholarship Director (November 2016-November 2018)
- Coordinated two events that raised over $18,000 which enabled organization to give out multicultural scholarships to students in need. Proven ability to gain community support and provide team leadership
Timeline
Claim Specialist
CNA Insurance
11.2023 - Current
Claim Case Manager
Travelers Insurance
09.2019 - 11.2023
Associate of Arts -
Waubonsee Community College
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