RISK MANAGEMENT PROGRAM SPECIALIST - 43000847

State of Florida•Tampa, FL

5d•$52,000 - $55,000•Onsite

About The Position

This position conducts investigations of State liability claims filed against the State and its employees. When necessary, specific claims will be 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 contract adjusters' activities during the investigation process and for the overall quality of claims management. This includes the continual review of claims files, litigation management (scrutinizing legal documents, discerning legal strategies, identifying possible additional claims and counterclaims), and maintaining a working knowledge of applicable laws. The role involves suggesting strategies to attorneys, assisting agencies in coordinating with defense attorneys, developing agreed plans of defense, and keeping the Administrator and involved agency personnel informed of significant case developments. The specialist is also responsible for authorizing settlements, attending mediations and trials, applying case law to determine liability for settlement exploration, evaluating medical reports and vendor bills, authorizing and making settlement offers, and adjusting claim reserves. Additionally, the role includes reviewing and approving vendor fees and expense statements, and maintaining the accuracy of claims information and reserves in the division's data processing system, including proper data coding and verification, and maintaining the file diary system.

Requirements

Proficient in using Microsoft Word and Excel.
Must be able to travel within Florida by driving a car and/or commercial airline.
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

One (1) or more years’ experience in the insurance field or adjusting liability claims.
Experience in the legal field or working with attorneys.
Experience in negotiations or conflict resolution.
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

Conduct 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.
Negotiate and settle claims filed against the state and/or employees.
Work with assigned counsel to resolve and defend claims brought against the state and employees.
Supervise and direct the contract adjuster’s activity during the investigation process.
Ensure the overall quality of claims management.
Conduct continual review of claims files.
Manage all facets of litigation, including scrutinizing summons and complaints, answers, motions, and other legal documents to discern legal strategies, possible additional claims and counter claims, etc.
Maintain a fundamental working knowledge of the statutory, case law, and procedural laws applicable to assigned cases.
Suggest to attorneys other strategies pertinent to the efficient and professional handling of each assigned claim.
Assist the agency involved, where appropriate, in coordinating with the defense attorney.
Develop, with the contract defense attorney, an agreed plan of defense.
Keep the Administrator and personnel of the involved state agency fully informed of significant case developments.
Authorize timely offers of judgment/proposals for settlement, offers of settlement, pre-trial settlements, and attend court ordered mediations and trials.
Apply appropriate case law and make a determination of liability for the purpose of exploring the desirability of settlement, based on facts derived from the claim investigation and/or pre-trial discovery.
Properly evaluate medical reports, vendor bills, and estimates of damage.
Authorize and make offers of settlement up to approved authority and deny claims when necessary.
Adjust and record claim reserve and reserve balances to reflect the monetary exposure on claim files.
Review, adjust, and approve all attorney and other contract vendors' fees and expense statements, including all travel and other expenses of vendors.
Maintain 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.
Ensure proper data coding into the system and accurate verification.
Effectively maintain the file diary system.