Erick Orta
Pembroke Pines
Summary
Driven professional with 18+ years of progressive experience investigating fraud, managing complex investigative matters, and supporting organizational risk mitigation efforts. Adept at leading collaborative initiatives, developing investigative strategies, mentoring investigative staff, and building strong partnerships with internal and external stakeholders. Dedicated to promoting operational excellence, fostering team development, and advancing the organization's fraud prevention and compliance objectives through effective leadership and strategic decision-making.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Special Lead Investigator
Citizens Property Insurance Corporation
Jacksonville, FL
03.2015 - Current
- Led complex investigations involving policyholders, agents, agencies, and claim-related parties to assess potential fraud exposure, contractual noncompliance, and operational risks, providing investigative findings and recommendations to key business partners.
- Shepherd-functional meetings with underwriting, claims, agency management, and legal partners to align investigative strategies, share findings, and drive informed case resolution decisions.
- Collaborated in the development and execution of strategic investigative initiatives, leveraging analytical research, coordinating complex case activities, and assigning responsibilities to team members to drive effective investigative outcomes.
- Developed and facilitated fraud awareness presentations for underwriting, claims, agency management, and SIU personnel, enhancing fraud detection efforts, referral quality, and investigative consistency across departments.
- Developed and facilitated fraud awareness presentations for underwriting, claims, agency management, and SIU personnel, enhancing fraud detection efforts, referral quality, and investigative consistency across departments.
- Established and maintained strong partnerships with local and state law enforcement agencies, facilitating collaborative investigations, knowledge sharing, and ongoing fraud awareness initiatives.
- Effectively managed competing investigative priorities by maintaining organized workflows, monitoring case progress, and ensuring timely execution of critical investigative activities.
- Served as a key liaison with law enforcement partners, coordinating evidence development and investigative support to assist in the prosecution of complex fraud-related matters.
SIU Investigator
Kemper Insurance Companies
Doral, FL
06.2009 - 03.2015
- Investigated suspicious auto insurance policyholders and medical providers for potential fraudulent anomalies in the insurance contract and claims file based on contractual best practices and obligations.
- Lead collaborative efforts with vendors to organize claim handling functions such as private surveillance and auto-accident reconstruction engineers to properly investigate complex investigations.
- Conducted extensive background and research on all investigative subjects and participants while analyzing findings to leverage and conduct required recorded interviews, examinations under oath, clinical inspections, prepared investigative reports and provided directions to business partners as appropriate.
- Maintain an effective diary management system to accurately and timely prioritize assignments in conjunction with the initiation of required tasks within each complex investigation.
- Initiated and coordinated meetings with business partners to discuss collaborative efforts and joint file handling to determine and reach the correct conclusion on investigations that require outside departmental handling from the claims department and legal units
- Attended depositions, mediations, arbitrations, pre-trial conferences, trails and other legal proceedings.
- Provided support to internal partners and colleagues which included the training and presentations of fraud awareness to promote quality referrals from the claims department and proper investigations and file handling within the SIU unit.
- Collaborated with local and state lae enforcement agencies on continuing educations and joint investigations.
Claims Adjuster /SIU Investigator
Star Casualty Insurance Company
Coral Gables, FL
06.2006 - 06.2009
- Investigated insurance claims, reviewed coverage and liability, prepared reports, and recommended payment or denial of claims.
- Reviewed medical records, police reports, and other documents related to claim investigations.
- Maintained detailed documentation of all activities related to assigned cases including correspondence, research notes, investigative reports, and settlement agreements.
- Interpreted policy language to determine coverage for insureds under various lines of business.
- Conducted interviews with claim participants to obtain additional information about the claim.
- Negotiated settlements with claimants or their representatives in order to resolve disputes quickly and economically.
- Analyzed facts of loss including photographs, diagrams, and other evidence to identify potential sources of recovery.
- Negotiated settlements with attorneys representing claimants to reach a fair resolution of the claim.
- Presented cases at mediation or arbitrations as needed to facilitate the dispute resolution process.
- Attended court hearings to provide testimony regarding specific cases or issues related to litigation.
- Conducted examinations under oath of policyholders to obtain information and rule out inconsistencies in the facts of loss, coverage, medical treatment, and prior claims history.
- Conducted field work such as medical inspections, scene investigations, residency verifications, and cold calls.
EUO Examiner
United Automobile Insurance Company
North Miami Beach, FL
08.2005 - 06.2006
Kemper
- Conducted examinations under oath with policyholders to obtain information relevant to the claim to rule out inconsistencies and obtain facts of loss, injuries, medical treatment and confirm coverage.
- Reviewed and analyzed claims to ensure accuracy of information, completeness of medical records, and compliance with policy terms.
- Prepared detailed reports outlining all pertinent case information used in making decisions regarding payment of benefits.
- Worked in partnership with internal partners to review findings a recommend appropriate actions based on findings including denial or approval of benefits payments.
- Worked in partnership with local and state law enforcement agencies on joint investigations and analytica support.
Education
Associate of Arts - Sociology - Currently enrolled
Miami Dade College
Miami, FLHigh School Diploma -
Hialeah Senior High School
Hialeah, FL2003
Skills
- Professional and Self-motivated
- Team Oriented Individual
- Strong Communication and Verbal Skills
- Coachable and Adaptable
- Efficient and Logical
- Critical Thinker
- Prioritizes and Collaborates
Certification
- Licensed Insurance Adjuster - 620 All Lines.
- Fraud Claim Law Specialist Certification (FCLS)
- Property Claim Law Specialist Certification (PCLA) - Currently enrolled.
Timeline
Special Lead Investigator
Citizens Property Insurance Corporation
03.2015 - Current
SIU Investigator
Kemper Insurance Companies
06.2009 - 03.2015
Claims Adjuster /SIU Investigator
Star Casualty Insurance Company
06.2006 - 06.2009
EUO Examiner
United Automobile Insurance Company
08.2005 - 06.2006
High School Diploma -
Hialeah Senior High School
Associate of Arts - Sociology - Currently enrolled
Miami Dade College
Education and Training
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