Marisa Dominguez
Auburndale,Florida
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
Claim Specialist
Aaa
2024.05 - Current
- Responded to inquiries from claimants, attorneys, medical providers. regarding the status of their claim.
- Applied risk management principles when making decisions about coverage disputes or denials.
- Identified potential fraud indicators and escalated to appropriate personnel for further investigation.
- Reviewed incoming claims for accuracy and completeness in accordance with policy provisions.
- Resolved difficult issues promptly while maintaining a high level of professionalism.
- Investigated, evaluated, and negotiated settlements of assigned claims.
- Maintained timely and accurate records of all claim activity.
- Analyzed medical reports, bills, legal documents, or other information related to claims.
- Attended continuing education courses related to insurance regulations and best practices.
Claims Litigation Adjuster
GEICO
2019.05 - 2024.05
- Resolved complex, severe exposure claims using high service oriented file handling
- Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred
- Maintained contact with claimants and attorneys to determine treatment status
- Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials
- Conducted day-to-day administrative tasks to maintain information files and process paperwork
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records
- Researched claims and incident information to deliver solutions and resolve problems
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability
- Researched claims and incident information to deliver solutions and resolve problems
- Consulted police and hospital records when needed
- Finalized Type files for insurance claim payment release
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records
- Resolved complex, severe exposure claims using high service oriented file handling.
Telephone Claims Representative II
GEICO
2018.04 - 2019.05
- Handled soft tissue bodily injury claims
- Handled soft tissue uninsured/underinsured injury claims
- Evaluated claims based on evidence provided
- Reviewed and adjuster reserves and authority accordingly
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
Telephone Claims Representative I/ PIP
GEICO
2017.03 - 2018.04
- Handled liability disputes by obtained evidence since as police reports, witness statements and recorded statements of all parties involved
- Identify and resolved PD excess claims within our insurerds limits
- Handled PIP payments for our insureds and investigated PIP coverages/sources.
CSR
GEICO
2015.06 - 2017.03
- Took FNOLs and assigned to appropriate level adjuster
- Set inspections for our insureds and clamaints for claims involving comprehensive coverage, collision coverage and property damage
- Helped identify the potential for PD excess claims and assigned to appropriate adjuster.
Education
Graduated with scholars designation -
Tenoroc High school
Lakeland, FL05.2014
Skills
- Insurance policy coverage
- Customer service
- Time management
- Bilingual
- Communication skills
- Settlement determinations
- Claims investigations
- Claims knowledge
- Medical billing
- Litigation experience
- Bodily injury settlements
- Negotiation and mediation experience
- Teamwork and Collaboration
- Client Interviews
- Multitasking
- Understanding of medical terms
Languages
Spanish
Limited Working
Timeline
Claim Specialist
Aaa
2024.05 - Current
Claims Litigation Adjuster
GEICO
2019.05 - 2024.05
Telephone Claims Representative II
GEICO
2018.04 - 2019.05
Telephone Claims Representative I/ PIP
GEICO
2017.03 - 2018.04
CSR
GEICO
2015.06 - 2017.03
Graduated with scholars designation -
Tenoroc High school
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