Michael Ortega
Saint Petersburg,FL
Summary
Results-driven claims professional with over 20 years of experience in investigating and processing claims to ensure fairness and compliance with insurance guidelines. Expertise as a multiline adjuster includes handling complex Homeowner and Commercial Lines, as well as Liability claims, with proficiency in Xactimate and XactAnalysis. Proven ability to manage litigation and arbitration cases, attending depositions, trials, and mediations as necessary while effectively communicating with lawyers, claimants, and policyholders throughout the investigation process. Strong analytical skills combined with a commitment to delivering favorable resolutions through effective negotiation and comprehensive case analysis enhance the ability to navigate challenging legal scenarios successfully. Professional with focus on achieving impactful results in litigation field. Known for successfully managing intricate claims and negotiating settlements that align with organizational goals. Highly collaborative team player with commitment to adapting to evolving demands and maintaining high standards in all tasks. Expertise in case analysis and conflict resolution.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Claims Litigation Adjuster Lead-Triage Review
Citizens Public Insurance Corp.
Florida
09.2021 - Current
- Review lawsuits and claim files and provide recommendations for the handling of new lawsuits.
- Proficient technical knowledge of estimating and repair methods and the ability to review and compare estimates for overlap, pricing, understand industry standards and repair options and assess the potential effect on jury views and trial outcomes.
- Capable of recognizing the potential deficiencies in a case and the need to a negotiate settlement as a potential resolution.
- Conducted structured audits of operational operational processes for Triage Litigation evaluations using established QA guidelines
- Provide accurate audit results in accordance with established QA standards.
- Assist management with the creation of strategic initiatives and the implementation litigation strategies.
- Accomplished abilities to interpret policy language and recognize potential ambiguities that could lead to potential adverse verdicts.
- Researches, analyzes, and interprets policy contracts and state statutes as it applies to submitted claims.
- Adept in conducting investigation, damage assessments and utilizing estimating software.
- Highly qualified to document all relevant information in the electronic claims management system
- Evaluated complex insurance claims to determine liability and settlement amounts.
- Collaborated with legal teams to ensure compliance with regulatory requirements.
- Analyzed case files and evidence to provide accurate recommendations for settlements.
- Led negotiations with claimants to reach mutually agreeable resolutions.
Senior Property Adjuster
USAA
Tampa, FL
10.2019 - 09.2021
- Provides Property claims service via internal channels to members and third-party customers.
- Adjusts moderately complex property claims with various levels of severity.
- Proficient in use Xactware products for estimating and collaboration of estimates.
- Acquires and applies basic knowledge of P&C insurance industry products, services, and processes to include P&C insurance policy contracts and coverages, and USAA claim handling process and procedures.
- Facilitate Property claims with Public Adjusters, Attorneys involving high severity property damage.
- Handle litigated files, civil remedy cases, and work collaboratively with defense counsel.
- Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs
- Review and interpret policy language and case law as it pertains to assigned claims.
- Led comprehensive property assessments to determine damage and loss for claims processing.
- Developed detailed reports and documentation to support claim resolutions and compliance.
- Facilitated communication between clients, contractors, and internal teams to ensure efficient claims handling.
- Trained junior adjusters on best practices for assessing damages and customer service techniques.
Temporary Commercial Property & Casualty Claims Representative
The Best IRS
Lakewood Ranch, Florida
07.2019 - 08.2019
- Investigated and settled Commercial Property and Casualty claims for Third Party Administrator.
- Provided coverage analysis for Commercial Property, Commercial Auto losses
- Ability to prepare detailed reports and recommendations to clients.
Temporary Commercial Liability Claims Representative
Quest Pro Temp Consultants
Tampa, FL
04.2019 - 06.2019
- Manage and control risk for specialty risk clients in a variety of different business fields.
- Ability to interpret policy language and provide coverage analysis.
- Ability to manage legal defense and handle time-sensitive matters.
- Processed liability claims efficiently, ensuring adherence to company policies and regulatory guidelines.
- Evaluated claim documentation for accuracy, identifying discrepancies to facilitate timely resolutions.
- Collaborated with cross-functional teams to streamline claims handling processes and improve customer satisfaction.
Inside Desk CAT Property Adjuster
Field Pros Direct
St. Petersburg, FL
09.2017 - 01.2019
- Oversee all phases of CAT property claims adjusting and review case reserves in assigned claims file to cover probable costs.
- Approving and adjusting estimates of damage and loss amounts
- Estimates costs of repair, replacement, or compensation.
- Examine claim forms and other records to establish insurance coverage and, approve and make adjustment estimates of damage and loss amounts.
- Proficient in the use of XactAnalysis
- Evaluated property damage claims for accuracy and adherence to policy guidelines.
- Collaborated with field teams to assess damages and determine repair needs.
- Conducted thorough investigations, documenting findings and ensuring compliance with regulations.
- Developed detailed reports outlining claim assessments and recommendations for resolution.
- Mentored junior adjusters on best practices in claim handling and customer service.
- Implemented process improvements that enhanced claims processing efficiency and accuracy.
- Facilitated communication between clients, contractors, and insurance companies to expedite resolutions.
- Led training sessions on new software systems for claims management and documentation tracking.
- Used Xactimate to compile estimates for personal property and structure damage.
Closing Specialist
Concentrix, Inc.
South Burlington, VT
10.2016 - 07.2017
- Headed vehicle inventory activities until the transportation carrier picks up the automobile or surrenders it to the dealership. Coordinated vehicle transactions with customers and dealerships at designated locations to conduct repurchase or replacement and ensure all necessary paperwork is gathered and complete.
- Completed title and registration of new vehicle if required and facilitated the submission of all paperwork to client.
- Streamlined closing procedures to enhance transaction accuracy and efficiency.
- Trained new team members on compliance standards and operational workflows.
- Coordinated cross-departmental communication to resolve client issues promptly.
- Analyzed closing documents for consistency and adherence to regulatory requirements.
- Developed training materials that improved team knowledge of closing processes.
- Led initiatives that reduced processing time, enhancing overall client satisfaction rates.
- Mentored junior staff on best practices for document review and quality assurance.
- Implemented process improvements that increased workflow efficiency across teams.
Property & Casualty Claims Representative
Vermont League of Cities & Towns
Montpelier, VT
11.2010 - 12.2015
- Investigated and settled Commercial Property and Casualty claims with an emphasis on litigated cases.
- Managed complex claims at every angle including litigation, coverage, damage analysis, experts, reserving, subrogation, and risk transfer.
- Provided coverage analysis for Commercial Property, Commercial Auto, General Liability, Professional Liability, Wrongful Termination claims
- Facilitated desk reviews of auto physical damage estimates resulting from Commercial Auto claims.
- Evaluated and processed casualty claims to determine coverage eligibility.
- Communicated with claimants to gather pertinent information and resolve inquiries.
- Investigated claims by reviewing documentation and conducting interviews with involved parties.
- Collaborated with defense counsel to handle complex claims and mitigate risks.
Education
Bachelor of Science - Political Science
SUNY PLATTSBURGH
Plattsburgh, NYSkills
- Claims investigation
- Litigation management
- Coverage and liability analysis
- Conflict resolution skills
- Reserve management
- Initiative-driven mindset
- Critical evaluation
Certification
- Appointed Florida 6-20 Adjuster License
- Associate in Claims (AIC)
Timeline
Claims Litigation Adjuster Lead-Triage Review
Citizens Public Insurance Corp.
09.2021 - Current
Senior Property Adjuster
USAA
10.2019 - 09.2021
Temporary Commercial Property & Casualty Claims Representative
The Best IRS
07.2019 - 08.2019
Temporary Commercial Liability Claims Representative
Quest Pro Temp Consultants
04.2019 - 06.2019
Inside Desk CAT Property Adjuster
Field Pros Direct
09.2017 - 01.2019
Closing Specialist
Concentrix, Inc.
10.2016 - 07.2017
Property & Casualty Claims Representative
Vermont League of Cities & Towns
11.2010 - 12.2015
Bachelor of Science - Political Science
SUNY PLATTSBURGH