What are the responsibilities and job description for the Insurance Claims Supervisor GL (State Risk Adjuster 5) position at State of Louisiana?
The Division of Administration/Office of Risk Management has a vacancy. This job title has an assigned pay grade of AS-617.
This vacancy will be filled by new hire or by promotion of a current permanent status classified employee.
Louisiana is a "State as a Model Employer" for People with Disabilities.
There is a Special Entrance Rate of $1,953.60 biweekly for this position.
A criminal history check may be conducted on all new hires as well as employees changing positions including promotions, demotions, details, reassignments and transfers. Also, prospective employees may be subject to pre-employment drug testing. New hires will be subject to employment eligibility verification via the federal government's E-verify system.
No Civil Service test score is required in order to be considered for this vacancy.
To apply for this vacancy, click on the “Apply” link above and complete an electronic application which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the information section of the Current Job Opportunities page.
Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.
Applicants qualifying based on college training or receipt of a baccalaureate degree will be required to submit an official college transcript to verify credentials claimed prior to appointment. Please make every effort to attach a copy of your transcript to your application. The transcripts can be added as an attachment to your online application or faxed to (225) 219-1041. The selected candidate will be required to submit original documentation upon hire.
For further information about this posting, please contact:
Erica R. Gay
HR Specialist
Division of Administration/Office of Human Resources
email: Erica.Gay@la.gov
ORM State Risk Adjuster 5 positions are supervisory, and employees work in one of three Casualty Claim Units, or in the Property Claims Unit. Personnel report to and receive administrative direction from the unit manager, a State Adjuster 6. The vacant position is in the Casualty Claim - General Liability Unit, where lines of coverage include premises–operations, public officials, professional, employment practices, personal injury, media and civil/constitutional rights.
Duties and responsibilities include, but are not limited to:
• Responsible for the comprehensive overview of all claim handling and management activities for claims, exercising first-line functional supervision over the State’s Third Party Administrator (TPA).
• Oversees work processes; reviews and approves or denies transactions that exceed authority levels delegated to TPA.
• Monitors and reviews the work of TPA desk examiners and claim adjusters. Exercises contract oversight, utilizing performance standards and guidelines in evaluating claim files and conducting performance reviews of the TPA and its employees.
• Develops and executes periodic in-depth file and performance reviews for a sufficient number of TPA claim files to ensure the adjudication of claims in compliance with TPA's contract terms.
• Examines and evaluates the handling and disposition of non-litigated claims involving, but not limited to, the level and extent of claim investigation, the assessment of liability, and settlement method or denial by the TPA.
• Receives and reviews Petitions, performs risk matter reviews, and processes Petitions to the Attorney General for legal opinions and assignment of defense counsel.
• Participates in team meetings and staffings with the Attorney General's Office, the TPA, and ORM personnel to discuss strategies and defense of the case. May attend mediations and trials, if warranted.
• Reviews claims involving litigation to ascertain whether defense counsel and TPA have conducted sufficient investigative activities. Assesses and evaluates if defense counsel has conducted appropriate discovery and is pursuing defense unique to the State. Obtains legal opinions and case evaluations from defense attorneys, especially in cases requiring legal interpretation and/or posing major financial losses to the State.
• Prepares and submits completed case analysis of State's liability with settlement recommendations to appropriate claims level and or Claims Council. Serves as a voting member of claims council, which authorizes claims settlements up to a limit of $5,000,000.
• Authorized to extend individual payment and settlement authority of $100,000 without additional approvals. Direct authority to increase total claim reserves up to and including $500,000 and to approve contract amendment requests up to $100,000 without additional approvals.
This vacancy will be filled by new hire or by promotion of a current permanent status classified employee.
Louisiana is a "State as a Model Employer" for People with Disabilities.
There is a Special Entrance Rate of $1,953.60 biweekly for this position.
A criminal history check may be conducted on all new hires as well as employees changing positions including promotions, demotions, details, reassignments and transfers. Also, prospective employees may be subject to pre-employment drug testing. New hires will be subject to employment eligibility verification via the federal government's E-verify system.
No Civil Service test score is required in order to be considered for this vacancy.
To apply for this vacancy, click on the “Apply” link above and complete an electronic application which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the information section of the Current Job Opportunities page.
Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.
Applicants qualifying based on college training or receipt of a baccalaureate degree will be required to submit an official college transcript to verify credentials claimed prior to appointment. Please make every effort to attach a copy of your transcript to your application. The transcripts can be added as an attachment to your online application or faxed to (225) 219-1041. The selected candidate will be required to submit original documentation upon hire.
For further information about this posting, please contact:
Erica R. Gay
HR Specialist
Division of Administration/Office of Human Resources
email: Erica.Gay@la.gov
MINIMUM QUALIFICATIONS:
A baccalaureate degree plus three years of professional level experience in insurance claims adjusting, nursing, allied heath fields, construction management, or as a practicing attorney.
SUBSTITUTIONS:
A master's degree in business or public administration, finance, accounting, statistics, insurance or risk management, safety or legal studies, nursing, allied health fields or construction management will substitute for one year of the experience.
SUBSTITUTIONS:
A master's degree in business or public administration, finance, accounting, statistics, insurance or risk management, safety or legal studies, nursing, allied health fields or construction management will substitute for one year of the experience.
Experience in the fields of accident investigation, insurance claims examining, insurance claims investigation or insurance claims adjusting will substitute for the required college training on the basis of 30 semester hours for one year of experience.
NOTE:
This substitution allows any combination of experience and college hours to substitute for the baccalaureate degree. Thirty semester hours of college training is accepted as equivalent to one year of work experience, and college credit in increments of fewer than 30 hours is prorated on this basis.
NOTE:
Any college hours or degree must be from an accredited college or university.
FUNCTION OF WORK:
To supervise a unit of claims adjusters for the State's multi-line property and casualty self-insurance program.
LEVEL OF WORK:
Supervisor.
SUPERVISION RECEIVED:
Broad review from the State Risk Adjuster 6.
SUPERVISION EXERCISED:
Line over lower level State Risk Adjusters.
LOCATION OF WORK:
Division of Administration and the Office of the Governor.
JOB DISTINCTIONS:
Differs from the State Risk Adjuster 4 by serving in a supervisory capacity and by a higher claim payment authority limit.
Differs from the State Risk Adjuster 6 by the absence of responsibility for the full claims adjusting division.
The Office of Risk Management (ORM) is the Division of Administration ancillary agency that administers the comprehensive risk management program for the State of Louisiana and is solely and statutorily responsible for managing all state insurance coverage, both purchased and self-insured, for workers’ compensation, property, and casualty exposures. ORM is responsible for managing all tort claims made against the State and department/agency/board/commission clients; and also serves as the State of Louisiana public facilities sub-recipient representative for FEMA Public Assistance Grants.ORM State Risk Adjuster 5 positions are supervisory, and employees work in one of three Casualty Claim Units, or in the Property Claims Unit. Personnel report to and receive administrative direction from the unit manager, a State Adjuster 6. The vacant position is in the Casualty Claim - General Liability Unit, where lines of coverage include premises–operations, public officials, professional, employment practices, personal injury, media and civil/constitutional rights.
Duties and responsibilities include, but are not limited to:
• Responsible for the comprehensive overview of all claim handling and management activities for claims, exercising first-line functional supervision over the State’s Third Party Administrator (TPA).
• Oversees work processes; reviews and approves or denies transactions that exceed authority levels delegated to TPA.
• Monitors and reviews the work of TPA desk examiners and claim adjusters. Exercises contract oversight, utilizing performance standards and guidelines in evaluating claim files and conducting performance reviews of the TPA and its employees.
• Develops and executes periodic in-depth file and performance reviews for a sufficient number of TPA claim files to ensure the adjudication of claims in compliance with TPA's contract terms.
• Examines and evaluates the handling and disposition of non-litigated claims involving, but not limited to, the level and extent of claim investigation, the assessment of liability, and settlement method or denial by the TPA.
• Receives and reviews Petitions, performs risk matter reviews, and processes Petitions to the Attorney General for legal opinions and assignment of defense counsel.
• Participates in team meetings and staffings with the Attorney General's Office, the TPA, and ORM personnel to discuss strategies and defense of the case. May attend mediations and trials, if warranted.
• Reviews claims involving litigation to ascertain whether defense counsel and TPA have conducted sufficient investigative activities. Assesses and evaluates if defense counsel has conducted appropriate discovery and is pursuing defense unique to the State. Obtains legal opinions and case evaluations from defense attorneys, especially in cases requiring legal interpretation and/or posing major financial losses to the State.
• Prepares and submits completed case analysis of State's liability with settlement recommendations to appropriate claims level and or Claims Council. Serves as a voting member of claims council, which authorizes claims settlements up to a limit of $5,000,000.
• Authorized to extend individual payment and settlement authority of $100,000 without additional approvals. Direct authority to increase total claim reserves up to and including $500,000 and to approve contract amendment requests up to $100,000 without additional approvals.
Salary : $3,904 - $7,658