MARCIA A. RODRIGUEZ
Summary
Claims professional with proven success in risk assessment, negotiation, and claims processing. Strong focus on team collaboration and achieving results, adaptable to changing needs. Skilled in policy analysis, dispute resolution, and customer service. Known for reliability, integrity, and effective communication.
Overview
9
9
years of professional experience
Work History
claims resolution specialist III
LIBERTY MUTUAL
01.2021 - Current
- Handle single and multi-party commercial line claims of low to moderate exposure and complexity within specific limits of Authority
- Document claims file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate exposure and complexity personal or commercial line claims
- Exercise judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence
- Also Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage
- Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate
- Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims
- Assess damages by calculating applicable damages or range of damages allowed by law
- Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits
- Meet quality standards by following best practices
- Ensure customer service by proactively communicating information; responding to inquiries; following customer protocols and may participating in customer marketing efforts
- Manage expenses by working within vendor approved networks and managing scope of work assigned to outside contractors
- Departs from approved vendors with manager approval, where in the best interests of the insured
- Calculated and negotiated diminished value claims
Personal Injury Adjuster (PIP)
GEICO
01.2016 - 01.2021
- Manages, investigates, and resolves claims
- Investigates and evaluates coverage, liability, damages, and settles Property Damage, Bodily Injury, PIP, UM/UIM claims within prescribed authority levels
- Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation
- Prepares for and attends trials, hearings and conferences and reports to Home Office and local management on status
- Confers with trial counsel and prepares trial reports
- Communicates with policyholders, witnesses, and claimants to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advises as to proper course of action
- Responds to various written and telephone inquiries including status reports
- Ensures adequacy of reserves
- Recommends reserve increases on cases in excess of authority
- Manages, investigates, obtains, and resolves total loss in line with state guidelines
- Calculated and negotiated diminished value claims
Education
Master's degree - Sociology
Queens College
01.2011
Business Administration and Management
Queensborough Community College of The City University of New York (CUNY)
01.2008
Skills
- Claims investigation
- New Business Development
- Policy coverage expert
- Billing procedures
- Liability determinations
- Marketing Campaigns
- Brand Development
- Facilitating Compelling Presentations
- Customer Service Excellence
- Solution-Based Selling
- Project Management
- Account Management
- Assertive Negotiation Tactics
- Needs Assessment
- Problem-Solving
Languages
Spanish
Full Professional
Timeline
claims resolution specialist III
LIBERTY MUTUAL
01.2021 - Current
Personal Injury Adjuster (PIP)
GEICO
01.2016 - 01.2021
Master's degree - Sociology
Queens College
Business Administration and Management
Queensborough Community College of The City University of New York (CUNY)