Ana Martinez, Arm Email & Phone Number

United States

United States

•Manage the claims team, complex workers’ comp and general liability claims, and oversee management of claims from multi-state programs•Lead workers’ comp and general liability claim policies/procedures and strategic decision making related to claims management•Provide oversight of claims and care management and responsible for maintaining relationships with representatives from insurance companies, medical providers, internal managers, defense attorneys and injured employees•Establish structure, organization, and a continual process improvement approach to claim management processes•Responsible for delivering pre-determined claim status reports to senior management including but not limited to; reserves and total net incurred statuses, historical trend analysis and identification of high-risk operation locations•Assign or delegate duties to claims team to ensure proper distribution of work activities based on skill set, regional assignments, specialties, etc.•Manage/oversee third party adjustors by evaluating performance, building/maintaining relationships, and escalating performance concerns•Serve as company’s primary point of contact and owner in supporting managing of claims across Flagship•Manage overall relationships with Supervisors/Managers and injured workers by maintaining open and effective communications regarding employee status and return-to-work transitions•Engage leadership team as needed to support managing of claims related to Workers’ Comp•Ensure detailed conversation logs for historical reference, document controls in accordance with HIPPA guidelines and overall efficient records maintenance system for workers’ compensation claims and related information•Coach new and existing Workers’ Comp Claim team members and build/develop team members on on-going basis •Participate in quarterly claims review meetings to expedite the closing of claims and identify additional areas of improvement

Dallas, Texas, United States

•Review incoming incidents from RMIS system and triage as appropriate•Field calls from venue managers with questions about the claim reporting process•Review initial claim facts and report to the insurance carrier based on company guidelines•Contact guests directly when needed to facilitate claim resolution and/or investigation•Support Senior Risk Manager with discovery efforts on general liability litigation•Coordinate the creation of claims with the insurance carrier and insurance broker•Process certificate of insurance, automobile insurance card requests, and risk-related invoices for payment while adhering to company guidelines•Create and maintain filing systems for risk management documents as well as maintain electronic filing system for historical and current risk programs•Coordinate the timely response to wage statement requests with payroll for work-related injury claims•Follow up with venue managers for more information on associate, auto, property, and guest incidents•Ensure new venues as well as existing locations have up-to-date Medical Provider Panels•Coordinate the proper submission of medical bills to the carrier for Workers’ Compensation (WC) claims•Facilitate return-to-work efforts between the injured team member, insurance adjuster, and venue manager•Review and approve/deny requests for claim denials for WC, oversee monopolistic WC programs, and facilitate WC legal discovery•Review and make recommendations to Director of Risk on WC surveillance requests•Process and track CCTV video requests as needed for investigations•Track and follow up on outstanding 1st party property claims ensuring the carrier has all the information needed to reimburse the company•Track and follow up on outstanding 3rd party property claims (subrogation) ensuring that claims are pursued in a timely manner and documentation is obtained from Facilities•Fulfill adjuster requests for lease agreements, vendor contracts, and venue level contact information

Dallas, Texas, United States

•Handles 1st party property claims of moderate severity and complexity as assigned.•Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates.•Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate.•Establishes timely and accurate claim and expense reserves.•Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.•Negotiates and conveys claim settlements within authority limits.•Writes denial letters, Reservation of Rights and other complex correspondence.•Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.•Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.•Manages file inventory to ensure timely resolution of cases.•Handles files in compliance with state regulations, where applicable.•Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.•Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.•Provides multi-line assistance in response to workforce management needs; including but not limited to external recruiting.•May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.

•Conduct investigations, including, but not limited to assessing policy coverage, investigation of non-questionable/questionable claims, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability.•Proactively manage inventory with documented plans of action and emphasis on file quality and data integrity to ensure timely and appropriate resolution or reassignment.•Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources where appropriate. Manage, resolve or reassign those claims where pre-injury return to work is unlikely.•Establish and update reserves to reflect claim exposure and document rationale. Identify exposures and establish appropriate reserves. Apply knowledge to determine causal relatedness of medical conditions.•Collaborate with internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy.•Complete required letters and state forms and any other required documents as required. Prepare necessary letters and state filings within statutory limits.•Evaluate claims for potential fraud.•Effectively manage litigation to drive files to an optimal outcome, including resolution of benefits. Understand and apply Medicare Set Asides and allocations.•Negotiate settlement of claims within designated authority. Evaluate and document a detailed settlement analysis, value and range. Refer claims beyond authority as appropriate based on exposure and established guidelines. •Participate in Telephonic and/or onsite File Reviews.•Respond to inquiries – verbal and written.•Communicate and complete denials on medical and indemnity issues.

•Front office administrative support for the Academic Directors & Executive Council and other units within the Kay Bailey Hutchinson Center for Energy, Law & Business •Process DEFINE documents and payment of services, tracking and processing various transactions in UT Market via Excel and UT Box, purchase office supplies through UT Market and Amazon for the office/staff, maintain/order kitchen supplies when needed, schedule copy machine maintenance and order copier supplies when needed•Reconciliation and accounts payable transactions on behalf of Texas Parents•Check student records with various programs and communicate the outcome to the appropriate office, i.e Texas Board of Law Examiners, Study Abroad through Disciplinary Clearance List, and other UT organizations•Greet visitors, answer main phone line, give assistance to callers and guests by routing to the appropriate entity, receive/check in deliveries, keep reception area organized and supplied with staff business cards and information, pick up and log mail, schedule and maintain conference rooms for staff and other departments through Outlook•Maintain messages on voicemail when out of office•Monitor and maintain three email accounts, maintain calendar for Staff requested time off, maintain running list of staff out of office and on campus emails

Austin, Texas Area

•Lead social media and marketing efforts to increase awareness of GlobalAustin in the local community. •Responsible for managing GlobalAustin Facebook, Twitter and LinkedIn. •Managed the distribution of the GlobalAustin newsletter to subscribers as well as updating the International Austin event calendar.•Assist the Associate Executive Director with the international foreign exchange program that sought to allocate host families with prospective students. •Assist with the International Coffee Morning - this program was designed to welcome international visitors to the area, offer them the opportunity to meet friends, share experiences and learn about Austin and Texas.

San Marcos, Texas, United States

•Demonstrated a strong commitment to service, a genuine curiosity and interest in people, authenticity, fashion & style sensibility, and exceptional selling skills.•Achieved personal sales and metric goals.•Built and maintained new and existing customer relationships.•Maintained a solid, organized client book which furthered customer relationships and generated consistent, proactive sales volume.•Lead by example and model behavior that reflects the company's core values.•Ensured a high level of customer service through extensive product knowledge and product ownership.•Contributed to maintaining all brand and operating standards to support brand consistency.•Appropriately managed conflict and demonstrated a high degree of maturity and integrity.•Supported a positive atmosphere that was fun, professional, productive and team oriented.

Master Of Arts, International Studies, Graduate School

Activities and Societies: Sigma Iota Rho International Honor Society Order of Omega Greek Honor Society Sigma Lambda Gamma Sorority Inc..

Bachelor Of Arts, International Studies & Spanish

Student Association for Campus Activities (SACA) - October 2008 to July 2009 •Assisted with organizing Texas State events such.