RISK MANAGEMENT PROGRAM SPECIALIST - 43000192

State of Florida•Tallahassee, FL

About The Position

Conducts investigations of State liability claims which are filed against the State and its employees. When necessary, assigns specific claims to contract adjusters for field investigation. Negotiates and settles claims filed against the state and or employees. Works with assigned counsel to resolve and defends claims brought against the state and employees Conducts investigations of State liability claims, which are filed against the State and its employees. When necessary, assigns specific claims to contract adjusters for field investigation. Responsible for supervising and directing the contract adjuster’s activity during the investigation process and 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 attorney’s other strategies pertinent to the efficient and professional handling of each assigned claim. Responsible for assisting the involved agency, 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 expense 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.

Requirements

One (1) or more years’ experience in the insurance field or claims handling experience in any capacity.
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 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 held a Florida Adjuster license.
Processing vendor invoices.
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.
Assigns specific claims to contract adjusters for field investigation.
Negotiates and settles claims filed against the state and or employees.
Works with assigned counsel to resolve and defends claims brought against the state and employees
Responsible for supervising and directing the contract adjuster’s activity during the investigation process and 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 attorney’s other strategies pertinent to the efficient and professional handling of each assigned claim.
Responsible for assisting the involved agency, 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
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 expense 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.