Karl Martos
San Diego,CA
Summary
Accomplished professional in complex claims management, specializing in bodily injury assessment and liability negotiation. Known for attention to detail and strategic resolution, driving successful outcomes in high-volume portfolios.
Overview
25
25
years of professional experience
Work History
Continuing Unit Examiner
GEICO
Poway, CA
12.2021 - Current
- Manage a high-volume portfolio of complex, ongoing bodily injury and liability claims. Including attorney represented and litigated cases requiring experienced investigation and strategic resolution.
- Conduct liability investigations including consulting with claimants, legal representatives, law enforcement, and witnesses to establish accurate facts of loss.
- Review coverage documents, policy language, state specific statues to determine coverage and exposure applicability on complex claims.
- Evaluated bodily injury claims by reviewing medical records, bills, treatment history, lost wage, and pain and suffering to determine appropriate compensation levels.
- Negotiate directly with plaintiff attorneys and claimants to achieve pre litigation settlements, minimizing indemnity exposure.
- Collaborated with legal teams to assess liability and negotiate settlements.
- Coordinate with defense counsel on litigated files, assist in discovery process including interrogatories, depositions, and production of documents.
- Collaborate with attorneys representing insureds in order to develop effective defense strategies.
- Negotiated settlement agreements during mediations or arbitrations.
- Analyzed financial data related to litigated matters to estimate reserves for future payments, supporting financial planning and risk management.
- Maintain accurate documentation and reserve accuracy in compliance with internal audit standards.
- Assist and mentor junior associates on complex file handling, coverage analysis, and negotiation strategies.
Telephone Claims Adjuster II
GEICO
Poway, California
01.2017 - 12.2021
- Evaluated claims to determine coverage and liability under policy terms.
- Conducted recorded statements from insureds, claimants, and witnesses; collaborated with medical professionals and law enforcement to complete thorough investigations.
- Negotiated settlements with claimants and attorneys, ensuring fair compensation based on policies.
- Identified subrogation potential and coordinated recovery opportunities
- Deliver a high standard of customer service in face paced, high volume call center environment while managing a demanding caseload with competing priorities.
Telephone Claim Adjuster I
GEICO
Poway, California
06.2013 - 01.2017
- Communicated decisions to policyholders regarding claim approvals or denials.
- Manage incoming auto claims, completing coverage verification, liability assessment, and damage evaluations for property damage losses.
- Assessed potential losses for insureds in accordance with applicable laws and regulations.
- Participated in training sessions related to new policies or procedures.
- Gathered information from various third parties to determine claim acceptability.
- Build rapport quickly with claimants and insureds, guiding them through the claims process with clarity and professionalism.
- Consistently met or exceeded quality, productivity, and customer satisfaction metrics.
Claims Representative
GEICO
Poway, CA
09.2008 - 06.2013
- Processed insurance claims efficiently for diverse customer situations.
- Provided guidance to customers regarding claim status and next steps.
- Processed a high volume of claims efficiently while maintaining quality standards.
- Handled customer inquiries regarding insurance policy coverage details and payment status updates.
- Coordinated and planned investigations of claims to confirm compensability and coverage.
Sales Representative
GEICO
Poway, California
01.2002 - 09.2008
- Engaged clients to identify insurance needs coverage options and recommend suitable policies.
- Collaborated with team members to streamline the sales process and improve efficiency.
- Conducted follow-ups with clients to maintain relationships and encourage renewals.
- Participated in training sessions to stay updated on industry trends and offerings.
- Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
Education
High School Diploma -
University City High School
San Diego, CA06-1996
San Diego State University
San Diego, CASkills
- Bodily injury assessment
- Liability negotiation
- Claims management
- Coverage analysis
- Strategic resolution
- Risk evaluation
- Problem solving
- Attention to detail
- Multitasking
- Effective communication
- Cross-functional collaboration
- Client-focused approach
- Time management
- Relationship management
Professional Highlights
- 25 years of experience in continuous service and advancement in one of the nation's largest auto insurers.
- Comprehensive experience across the claims lifecycle.
- Proven ability to manage attorney-represented and litigated claims with demonstrated results in settlement negotiations and litigation cost control.
- Highly motivated examination professional, with efficiency in processing a high volume of claims while ensuring accuracy and state compliance.
Timeline
Continuing Unit Examiner
GEICO
12.2021 - Current
Telephone Claims Adjuster II
GEICO
01.2017 - 12.2021
Telephone Claim Adjuster I
GEICO
06.2013 - 01.2017
Claims Representative
GEICO
09.2008 - 06.2013
Sales Representative
GEICO
01.2002 - 09.2008
High School Diploma -
University City High School
San Diego State University