Insurance Coverage Officer

State of Delaware•Dover, DE

About The Position

This position adjusts insurance claims (Automobile and Property & Casualty) for the State of Delaware, its agencies, school districts, higher education institutions, and its employees. Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here. Performs coverage analysis, investigation, evaluation, negotiation, and deposition of insurance claims for all lines of insurance except health, life and disability managed and paid on behalf of the State of Delaware. This includes conducting research, collecting data, performing investigations, mediating disputes and negotiating claim settlements when appropriate. Provides expertise on behalf of the State on insurance programs and other insurance claims questions. Makes proper determination of coverage, legal liability, and damages to effect settlement of claims. Directs contracted appraisers, investigators, rehabilitation specialists, adjusters, and attorneys in adjudicating claims. Prepares Request For Proposals (RFPs) for insurance coverage and other contracted services. Researches federal and state statutes and insurance regulations and keeps abreast of new and/or revised pending legislation for potential impact on the State. Prepares files with required forms exhibits and reports to assist in litigation management and maintains a working diary for each assigned claim file. Maintains records and reports of the self-insurance fund. Ensures all subrogation is promptly identified, the responsible party is documented in an automated information system and subrogation letters are sent to responsible parties.

Requirements

Possession of a Delaware Insurance Adjuster's License in one or more of the following lines of authority: Casualty, Motor Vehicle, Workers Compensation, or Property.
Six months experience in investigating, evaluating and negotiating insurance claims and making determinations for coverage, legal liabilities and damages affecting the settlement of claims.
Three years experience in interpreting insurance laws, rules, regulations, standards, policies and procedures.
Six months experience in narrative report writing.
Knowledge of medical terminology.
Applicants must be legally authorized to work in the United States.

Responsibilities

Performs coverage analysis, investigation, evaluation, negotiation, and deposition of insurance claims for all lines of insurance except health, life and disability managed and paid on behalf of the State of Delaware.
Conducting research, collecting data, performing investigations, mediating disputes and negotiating claim settlements when appropriate.
Provides expertise on behalf of the State on insurance programs and other insurance claims questions.
Makes proper determination of coverage, legal liability, and damages to effect settlement of claims.
Directs contracted appraisers, investigators, rehabilitation specialists, adjusters, and attorneys in adjudicating claims.
Prepares Request For Proposals (RFPs) for insurance coverage and other contracted services.
Researches federal and state statutes and insurance regulations and keeps abreast of new and/or revised pending legislation for potential impact on the State.
Prepares files with required forms exhibits and reports to assist in litigation management and maintains a working diary for each assigned claim file.
Maintains records and reports of the self-insurance fund.
Ensures all subrogation is promptly identified, the responsible party is documented in an automated information system and subrogation letters are sent to responsible parties.