Insurance Claims Supervisor GL (State Risk Adjuster 5)

• Overseeing the states capital construction program
• Working to provide state and federal grants for community development
• Development of the state budget
• Providing technology services
• Giving agencies guidance in the state purchasing and contracting process as they seek goods and services
• Administering a program that provides federal funds to help Louisiana residents recover from a series of devastating hurricanes

Six years of experience in insurance claims adjusting examining or investigation; accident investigation legal research project management contract management or construction management; OR

Six years of full-time work experience in any field plus three years of experience in insurance claims adjusting examining or investigation; accident investigation legal research project management contract management or construction management; OR

A bachelors degree plus three years of experience in insurance claims adjusting examining or investigation; accident investigation legal research project management contract management or construction management; OR

An advanced degree in risk management or insurance business or public administration safety or legal studies construction management or a health services field plus two years of experience in insurance claims adjusting examining or investigation; accident investigation legal research project management contract management or construction management.

EXPERIENCE SUBSTITUTION:
Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.

The official job specifications for this role as defined by the State Civil Service can be found here.

Job Duties:
Responsible for the comprehensive overview of all claim handling and management activities for claims exercising first-line functional supervision over the States 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 TPAs 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 Generals 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 a 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 States liability with settlement recommendations to the appropriate claims level and or Claims Council. Serves as a voting member of the claims council which authorizes claims settlements up to a limit of $5000000.

Authorized to extend individual payment and settlement authority of $100000 without additional approvals. Direct authority to increase total claim reserves up to and including $500000 and to approve contract amendment requests up to $100000 without additional approvals.


Position-Specific Details:
Appointment Type:This vacancy will be filled by either a new hire or the promotion of a current permanent-status classified employee.

Louisiana is a State as a Model Employer for People with Disabilities.


How To Apply:

No Civil Service test scoreis 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.

*Information to support your eligibility for this job title must be included in the application (i.e. relevant detailed experience/education).Resumeswill notbe accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.

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 governments E-Verify system.

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. 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: