Margie Caraballo
Homestead
Summary
Dynamic, results-driven professional dedicated to making a significant impact in the business world by elevating workplace standards and fostering a culture of excellence. Possesses a robust background in assessing and resolving bodily injury claims efficiently and fairly, adept at managing complex cases while ensuring strict compliance with industry regulations. Strong negotiation and analytical skills contribute to delivering optimal outcomes, consistently enhancing client satisfaction and trust. Committed to driving positive change and achieving exceptional results in every endeavor.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Bodily Injury Claims Adjuster & Trainer
Progressive Insurance
05.2017 - 09.2025
- Responsibilities:
- Investigation and Evaluation
- Verify coverage: Determine whether the insurance policy is valid and covers the specific injuries and circumstances of the loss.
- Gather information: Collect all relevant facts and evidence, including police reports, photographs from the scene, accident reports, and other documentation.
- Interview parties: Take statements from the claimant, insured individuals, and witnesses to understand how the accident occurred and gather details about the injuries.
- Review medical documentation: Carefully examine medical records, bills, and reports from doctors and specialists to assess the extent and severity of injuries and determine if the costs are reasonable.
- Assess damages: Evaluate all aspects of the damages, including medical costs, lost wages, future earning capacity, and subjective elements like pain and suffering.
- Determine liability: Use the gathered information to decide who was at fault for the accident and the degree of fault, which impacts the potential payout.
- Identify fraud: Investigate questionable claims to ensure they are not fraudulent or criminal activity is not involved.
- Claims Management and Resolution
- Establish reserves: Independently evaluate the claim's value and set appropriate financial reserves to cover the potential payout.
- Communicate with stakeholders: Provide ongoing status updates to the insured and claimants, and manage communication with attorneys, healthcare providers, and external vendors like private investigators.
- Negotiate settlements: Engage in negotiations with claimants, their legal representatives, or other insurance carriers to reach an equitable and efficient resolution.
- Authorize payments: Approve and process payments for medical bills, repair costs, and final settlements within the designated authority limits.
- Coordinate litigation: Work closely with defense counsel on litigated claims, which may involve attending depositions, mediations, and trials to defend the insurer's position.
- Maintain documentation: Ensure all claim files and related records are accurately documented and comply with company policies and state regulatory requirements.
- Bodily Injury Claims Adjuster Training & Development
- Curriculum Design & Delivery: Design, develop, and deliver comprehensive training programs focused on bodily injury claims handling, including policy interpretation, liability determination, medical record review, damage assessment, negotiation strategies, and fraud detection.
- Mentorship & Coaching: Provide ongoing coaching, guidance, and mentorship to claims adjuster trainees and junior staff, supervising their initial caseloads and ensuring adherence to best practices and quality claim handling standards.
- Expert Consultation: Act as a subject matter expert and lead staff member in bodily injury claims, assisting adjusters with complex or unusual cases and providing expert guidance on challenging claim scenarios.
- Quality Assurance & Compliance: Monitor staff activity and outcomes through file reviews and observations to ensure compliance with state regulatory requirements, licensing stipulations, and internal company policies.
- Performance Evaluation & Feedback: Assess trainee performance through testing, role-playing, and file audits; provide constructive feedback and implement tailored development plans to improve analytical skills, decision-making, and communication abilities.
- Resource Development: Create and maintain up-to-date training materials, job aids, and resources, incorporating new developments in case law, medical terminology, and insurance industry best practices.
- Litigation & Negotiation Support: Train adjusters on effective negotiation tactics for settlements with claimants and attorneys, and instruct on coordination with defense counsel during litigated claims, including preparation for depositions and mediations.
- System & Software Training: Facilitate training on claims management software and related systems, ensuring trainees can accurately document files, establish reserves, and process payments efficiently.
Customer Service Team Lead
Assurant Solutions
09.2015 - 05.2017
- Responsibilities: Verbally collect pertinent information from customer over the phone, answer routine questions and resolve basic problems based on Assurant Company guidelines and values; follow standard screens/scripting as appropriate; process and determine coverage on each claim; maintain and update customer records as needed, maintain professionalism and effectively interact with all contacts, both internal and external, maintain department quality standards and perform job duties as directed by supervisor
Part Time Associate, Team Lead, and Assistant Store Manager
Party City
08.2011 - 08.2015
- Responsibilities: Assist Store Manager by Increasing effectiveness through the use of recruiting, selecting, orienting, training, coaching, counseling, and disciplining associates; communicate values, strategies, and objectives; assigning accountability, planning , monitoring, and appraising job results; developing incentives; developing a climate for offering information and opinions; providing educational opportunities; studying financial opportunities; recommending objectives to further develop associates; assisting with establishing budgets; allocating resources; reviewing progress of associates; making any necessary mid-course corrections; building company image by collaborating with customers, community organizations, and employees; enforcing ethical business practices; assist in maintaining and enforcing company standards; maintain professional knowledge by attending business workshops; participate in weekly conference calls; host weekly management meetings to ensure management is up to date with any/all pending projects; assist with store maintenance by communicating with District Manager for supplies, repairs, etc
Assistant Store Manager
GameStop
05.2014 - 11.2014
- Responsibilities: Assist Store Manager by Increasing effectiveness through the use of recruiting, selecting, orienting, training, coaching, counseling, and disciplining associates; communicate values, strategies, and objectives; assigning accountability, planning , monitoring, and appraising job results; developing incentives; developing a climate for offering information and opinions; providing educational opportunities; studying financial opportunities; recommending objectives to further develop associates; assisting with establishing budgets; allocating resources; reviewing progress of associates; making any necessary mid-course corrections; building company image by collaborating with customers, community organizations, and employees; enforcing ethical business practices; assist in maintaining and enforcing company standards; maintain professional knowledge by attending business workshops; participate in weekly conference calls; host weekly management meetings to ensure management is up to date with any/all pending projects; assist with store maintenance by communicating with District Manager for supplies, repairs, etc
Part Time Associate, Assistant Store Manager, Executive Manager, and General (Store) Manager
Halloween City
08.2010 - 11.2012
- Responsibilities: Build/Tear down local for seasonal use; Increase effectiveness through the use of recruiting, selecting, orienting, training, coaching, counseling, and disciplining associates; communicate values, strategies, and objectives; assign accountability, plan , monitor, and appraise job results; develop incentives; develop a climate for offering information and opinions; provide educational opportunities; study financial opportunities; recommend objectives to further develop associates; establish budgets; allocate resources; review progress of associates; make any necessary mid-course corrections; build company image by collaborating with customers, community organizations, and employees; enforce ethical business practices; maintain and enforce company standards; maintain professional knowledge by attending business workshops; participate in weekly conference calls; host weekly management meetings to ensure management is up to date with any/all pending projects
Part Time Desk Clerk, Full Time Lead Clerk, Tax Preparer, and Senior Tax Preparer
Carza Corp
01.2006 - 04.2012
- Responsibilities: Compute taxes owed by following the tax code; prepare simple to complex tax returns for individuals or small businesses; help taxpayers by using their federal, state, and local codes and see that clients receive their maximum benefit permitted under the law of government; uncover potential deductions and credits; advise against potential tax liabilities; ensure clients do not pay unnecessary taxes; review financial records such as income statements and documentation of expenditures; interview clients to get a thorough picture of financial situation; verify totals on past forms for accuracy; calculate and invoice for form preparation fees; consult tax law handbooks for difficult returns; resolve customer complaints; recommend additional products and services; prepare tax returns using electronic filing software; ensure a copy of the return is provided to the customer; attend educational seminars to keep up to date with current tax laws/practices; pass any/all required examination needed to keep PTIN number for upcoming tax year
Education
Bachelor - Biology
Miami Dade Community College
Miami, FLPre-Veterinary Medicine
Robert Morgan Educational Center
Miami, FL01.2008
Skills
- Medical records analysis
- Claims investigation
- Litigation management
- Policy interpretation
- Liability assessment
- Negotiation
- Damage evaluation
- Bodily injury settlements proficiency
- Total loss handling
- Proficiency of bodily injury claims
- Complex coverage issues
- Insurance regulations
- Insurance policy coverage expertise
- Customer service
- Problem-solving
- Highly motivated
- Attention to detail
- Multitasking and organization
- Critical thinking
- Team collaboration
- Verbal and written communication
- Decision-making
- Advanced oral and written communication skills
- Conflict resolution
- Property valuation
- Risk assessment
- Policy investigations
- Casualty and property loss
- Healthcare common procedures coding system (HCPCS)
- Interviewing techniques
- Settlement management
- Claims file documentation
- Evidence reviews
- Fact finding
- Insurance policy coverage knowledge
- Settlement negotiation
Accomplishments
- Served as Lead Adjuster for over 1200 complex claims.
- Achieved Overall team efficiency through effectively helping with Claims Management.
Certification
- Licensed Claims Adjuster - May 2017-September 2025
Communication
- -Selected to assist in the training of new adjusters 6 months after beginning my position (Progressive Insurance)
- - Led Branch Meetings and showed efficient ways to handle claims (Progressive Insurance)
- - Assisted struggling adjusters one on one in order to improve their performance and efficiency (Progressive Insurance)
- - Completed a 6 month rotation in Progressive’s sister company, ASI to become a Homeowner claims adjuster and handled water damage home claims in Florida (Progressive Insurance)
- - Worked for 6 months to assist 3 separate branches, Cutler Bay, Miramar, and Ft. Myers, with their dated claims and brought the claims to resolution (Progressive Insurance)
- - Had the highest possible authorization for an adjuster in my position and was entrusted with clearing more complex coverage claims (Progressive Insurance)
- -Selected for test group for new IVR transfer system (Assurant Solutuions)
- -Selected to side jack multiple times to assist associates that require additional help on the lines. (Assurant Solutuions)
- -Selected to become Bilingual Universal Agent. (Assurant Solutuions)
- -Assisted Supervisor with QA disputes for teammates on multiple occasions (Assurant Solutions)
- -Youngest General Manager in the history of the company (Halloween City)
- -Hired, trained, and maintained 30+ employees during Halloween, also responsible for separation of employment after seasonal position ended (Halloween City)
- -During 2012, managed 3 different locations, Sunset, Kendall, and Coral Reef (Halloween City)
- -Implemented marketing tactics that boosted sales by 15% (Party City)
- -While Team Lead, managed employee scheduling, improving productivity and coming in under budget for hours (Party City)
- -Only manager trained in Inscribe program, able to create banners, invitations, pens, luggage tags, etc… (Party City)
- -Implemented customer referral program that drastically increased clientele (Carza Corp)
- -Notary Public for the State of Florida since 2009 (Carza Corp)
- -Was asked to singlehandedly host and plan biggest game release of the year, Destiny (GameStop)
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
French
Limited Working
Italian
Limited Working
Timeline
Bodily Injury Claims Adjuster & Trainer
Progressive Insurance
05.2017 - 09.2025
Customer Service Team Lead
Assurant Solutions
09.2015 - 05.2017
Assistant Store Manager
GameStop
05.2014 - 11.2014
Part Time Associate, Team Lead, and Assistant Store Manager
Party City
08.2011 - 08.2015
Part Time Associate, Assistant Store Manager, Executive Manager, and General (Store) Manager
Halloween City
08.2010 - 11.2012
Part Time Desk Clerk, Full Time Lead Clerk, Tax Preparer, and Senior Tax Preparer
Carza Corp
01.2006 - 04.2012
Pre-Veterinary Medicine
Robert Morgan Educational Center
Bachelor - Biology
Miami Dade Community College