RISK MANAGEMENT PROGRAM SPECIALIST - 43001294

State of Florida•Tallahassee, FL

11d•Onsite

About The Position

This position is responsible for conducting investigations of State liability claims filed against the State and its employees. The specialist will assign claims to contract adjusters for field investigation, supervise their activities, and ensure the overall quality of claims management. Responsibilities include the continual review of claims files and direct management of litigation, which involves scrutinizing legal documents to identify legal strategies and potential counterclaims. The role requires a fundamental understanding of applicable statutory, case law, and procedural laws, and the ability to suggest defense strategies to attorneys. The specialist will also assist agencies in coordinating with defense attorneys, develop agreed-upon defense plans, and keep administrators and agency personnel informed of significant case developments. Additionally, the position is responsible for authorizing settlement offers, attending mediations and trials, evaluating medical reports and damages, authorizing settlements up to approved limits, and denying claims when necessary. The role also involves adjusting and recording claim reserves, approving vendor fees and expenses, and maintaining the accuracy of claims information and reserves in the division's data processing system, including file diary maintenance.

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; to investigate insurance claims; understand and apply applicable rules, regulations, policies and procedures; collect, analyze and interpret data; to make and defend decisions about insurance claims; plan, organize & coordinate work activities; communicate effectively verbally & in writing; and 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 resolution 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 previously 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.
Supervising and directing the contract adjuster’s activity during the investigation process and responsible for the overall quality of claims management.
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 to discern legal strategies, possible additional claims and counter claims, etc.
Having and maintaining a fundamental working knowledge of the statutory, case law, and procedural laws applicable to assigned cases and for suggesting to attorney’s other strategies pertinent to the efficient and professional handling of each assigned claim.
Assisting the involved agency, where appropriate, in coordinating with the defense attorney.
Developing, with the contract defense attorney, an agreed plan of defense.
Keeping the Administrator and personnel of the involved state agency fully informed of significant case developments.
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.