Martha Macias-Kurtz
Travelers Rest
Summary
Detailed and Results-oriented Claim Examiner with over 30 years of experience. Strong command of conflict resolution and negotiation combined with excellent reporting and research skills. Thorough understanding of claims process and continuous understanding of legal jurisdictional trends.
Overview
33
33
years of professional experience
1
1
Certification
Work History
Complex Claims Specialist
Gramercy Risk Management
04.2023 - Current
- Managed a high volume of NY Labor Law, Commercial General Liability, and Professional Liability claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Composed detailed reports to the carrier based on legal venue, medical values, in addition to jurisdictional value reports from defense counsel.
- Developed strong working relationships with defense counsel, plaintiff counsel, and third party adjusters, including excess adjusters to facilitate a claims resolution.
- Settled complex claims by applying critical thinking, negotiation arguments, and detailed knowledge of mechanism of injury and insurance policies.
- Collaborated within my internal team to gain knowledge of their professional perspective.
- Regularly attend NY Labor Law CE's to maintain an awareness current legal issues.
Claims Examiner
Sedgwick CMS
07.2021 - Current
- Commercial General Liability, TPA multi-state handling, and awareness of changing litigation trends.
- Compose status reports to alert carrier of serious injuries with reserve and SIU recommendations.
- Research and negotiate injury claims based on liability, negligence laws, and value of injuries.
- Analyze, investigate coverage issues, report coverage issues to carrier.
- Worked with private investigators and attorneys on preparation of evidence, other documentation in preparation for mediation and trial.
- Attend and negotiate mediation on behalf of the carrier.
- Obtained contracts and certificates of insurance to verify insurance requirements, indemnification and defense clauses.
- Facilitate meetings with defense counsel.
- Handle premises liability, product liability, maritime law, directors and officers claims.
- Recognize red flags to utilize SIU for additional investigation.
- Collaborate with internal and external customers.
Senior Claims Representative
North American Risk Services
10.2017 - 07.2021
- Commerical Auto and General liability withTPA multi-state exposure.
- Negotiated claim settlements with claimants, attorneys, and at mediation to resolve claims efficiently and fairly.
- Multi-state claims litigation, with understanding of venue profiles, State requirements, and trends.
- Prepared large loss reports to inform Carriers of reserve recommendations and presentations at round table.
- Notify SIU to conduct additional investigation.
Commercial Underwriter
Auto Owners
02.2017 - 06.2017
- Scrutinized underwriting performance to identify weaknesses and liability exposure to provide recommendations for improvement.
- Evaluated applications to determine insurance coverage and appropriate risk classifications.
- Analyzed data to identify trends and predict future insurance needs.
Claims Specialist
State Farm
10.1991 - 11.2015
- Complex handing of complex bodily injury, litigation, and property damage claims while maintaining reasonable inventory.
- Volunteered and trained for Catastrophe Home Owners Claims.
- Adjusted fast paced claims in high volume team environment.
- Reviewed new files to determine current status of injury claim and to develop plan of action and reserving.
- Escalated files with significant indemnity exposure to supervisor for further investigation.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle negotiations or arbitrations.
- Conducted full claim investigations and reported updates and legal actions.
- Negotiated with other involved parties to arrange settlements.
Education
Bachelor of Science - Fashion Merchandising
Northern Illinois University
Dekalb, IL05.1991
Skills
- Claims Understanding of First, Third Party Claims for Personal and Commercial lines
- Critical thinking, problem solving, aggressive claims investigation, and analysis of liability
- Reading and Writing Comprehension in Spanish
- Analysis of mechanism of injury
- Conflict resolution
- Self motivated and Team Player in remote virtual environment
Certification
- AIC - American Institute for Chartered Property Casualty Underwriters
- Licensed in Alaska, Alabama, Arkansas, Arizona, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, North Carolina, New Hampshire, New Jersey,New Mexico, New York, Oklahoma, Oregon, South Carolina, Texas, Vermont, Washington, West Virginia, and Wyoming
Languages
Spanish
Full Professional
Timeline
Complex Claims Specialist
Gramercy Risk Management
04.2023 - Current
Claims Examiner
Sedgwick CMS
07.2021 - Current
Senior Claims Representative
North American Risk Services
10.2017 - 07.2021
Commercial Underwriter
Auto Owners
02.2017 - 06.2017
Claims Specialist
State Farm
10.1991 - 11.2015
Bachelor of Science - Fashion Merchandising
Northern Illinois University
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