RISK MANAGEMENT PROGRAM SPECIALIST - 43000332

State of Florida•Tallahassee, FL

12d•Onsite

About The Position

This position conducts investigations of State liability claims filed against the State and its employees. When necessary, specific claims are assigned to contract adjusters for field investigation. The role involves negotiating and settling claims filed against the state and/or employees, and working with assigned counsel to resolve and defend claims brought against the state and employees. The specialist is responsible for supervising and directing the contract adjuster’s activity during the investigation process and for the overall quality of claims management. This includes the continual review of claims files, direct responsibility for all facets of litigation management, scrutinizing legal documents, and suggesting strategies to attorneys. The position requires maintaining a working knowledge of applicable laws and assisting agencies in coordinating with defense attorneys. Developing an agreed plan of defense with the contract defense attorney and keeping the Administrator and personnel of the involved state agency informed of significant case developments are also key responsibilities. The role involves authorizing settlements, proposals for settlement, and attending mediations and trials. Based on facts derived from investigations and discovery, the specialist determines liability for settlement purposes, evaluates medical reports, vendor bills, and damage estimates, and authorizes settlements up to approved authority or denies claims. Adjusting and recording claim reserves to reflect monetary exposure and reviewing, adjusting, and approving all attorney and other contract vendor fees and expense statements are also part of the duties. The position requires overall maintenance of claims information in the division's data processing system, including accuracy of claims information and reserves, proper data coding, and accurate verification, as well as effective maintenance of the file diary system.

Requirements

One (1) or more years’ experience in the insurance field or adjusting liability claims.
Proficient in using Microsoft Word and Excel.
Knowledge of the principles of insurance & risk management; of methods of compiling, organizing, & analyzing data.
Ability to conduct fact-finding interviews.
Ability to investigate insurance claims.
Ability to understand and apply applicable rules, regulations, policies and procedures.
Ability to collect, analyze and interpret data.
Ability to make and defend decisions about insurance claims.
Ability to plan, organize & coordinate work activities.
Ability to communicate effectively verbally & in writing.
Ability to establish & maintain an effective working relationship with others.

Nice To Haves

Experience in the legal field or working with attorneys.
Experience in negotiations or conflict resolutions or attended classes in this area of study.
Experience working in a Risk Management Information System, Insurance Management system, or similar claims database.
Currently have or have held a Florida Adjuster license.
Bachelor’s degree from an accredited college or university.

Responsibilities

Conducts investigations of State liability claims which are filed against the State and its employees.
Assign specific claims to contract adjusters for field investigation when necessary.
Negotiates and settles claims filed against the state and/or employees.
Works with assigned counsel to resolve and defend claims brought against the state and employees.
Supervises and directs the contract adjuster’s activity during the investigation process.
Responsible for the overall quality of claims management.
Responsible for the continual review of claims files.
Directly responsible for all facets of litigation management to include scrutinizing summons and complaints, answers, motions, and other legal documents in order to discern legal strategies, possible additional claims and counter claims, etc.
Responsible for having and maintaining a fundamental working knowledge of the statutory, case law, and procedural laws applicable to assigned cases and for suggesting to attorneys’ other strategies pertinent to the efficient and professional handling of each assigned claim.
Responsible for assisting the agency involved, where appropriate, in coordinating with the defense attorney.
Responsible for developing, with the contract defense attorney, an agreed plan of defense.
Responsible for keeping the Administrator and personnel of the involved state agency fully informed of significant case developments.
Responsible for authorizing timely offers of judgment/proposals for settlement, offers of settlement, pre-trial settlements, and for attending court ordered mediations and trials.
Based on facts derived from the claims investigation and or pre-trial discovery, responsible for applying appropriate case law and making a determination of liability for the purpose of exploring the desirability of settlement; related to this responsibility is the need to properly evaluate medical reports, vendor bills, and estimates of damage; responsible for authorizing and making offers of settlement up to approved authority and denying claims when necessary.
Responsible for the adjustment and recording of claim reserve and reserve balances to reflect the monetary exposure on claim files.
Responsible for the review, adjustment, and approval of all attorney and other contract vendors' fees and expense statements, including all travel and other expenses of vendors.
Responsible for the overall maintenance of the claims information contained in the assigned claim files, including the accuracy of the claims information and reserves in the division's data processing system.
This includes proper data coding into the system and accurate verification.
Responsibility also includes the effective maintenance of the file diary system.