St Risk Adjuster 5

The State Risk Adjuster 5 (Supervisor) is a supervisory position within the Office of Risk Management (ORM) working in the Casualty Claims Section Workers Compensation Unit. ORM is the Division of Administration ancillary agency that administers the comprehensive risk management program for the State of Louisiana and is solely responsible for managing all state insurance coverage both purchased and self-insured for workers compensation property and casualty exposures. ORM is also responsible for managing all tort claims made against the State or its agencies; and at the designation of the Commissioner of Administration serves as the State of Louisiana public facilities sub-recipient representative for Federal Emergency Management (FEMA) Agency Public Assistance (PA) Grants under Subpart G Title 44 Code of Federal Regulations.

The incumbent has first line supervisory responsibility to oversee and monitor within his/her assigned areas of responsibility the contractual claims handling activities performed by the States Third Party Administrator (TPA). The position focus is on Workers Compensation Jones Act and Employer Liability claims filed for an accident arising out of the general course of employment. The incumbent reports to and receives broad review from the State Risk Adjuster 6 (Manager).

• 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 the claim handling and management activities completed by the TPA. This oversight includes the investigation and management of workers compensation Jones Act accidents and injuries and Employer Liability claims both litigated and non-litigated administered by the Self-Insurance Fund.

Performs multiple complex reviews of activities performed by the TPA as it relates to claims handling and the work of its employees.

Assists the State Risk Administrator and Manager develop revise and utilize documents that together compose contract management plans outlining the way the TPA contract is administered supported monitored and evaluated. This includes:

(1) Client Instructions given to guide contractors on how to handle State claims;
(2) Monitoring Plans to identify processes and procedures followed by Contractors employees work are in compliance with policies laws regulations industry best practices etc.
(3) Interim Performance Evaluations completed to assess and report performance outcomes.

These contract administration plans ensure the claim service provider is controlling the cost of claims and losses represents the best interests of the State of Louisiana complies with the laws and regulations governing the disposition and handling of claims and is providing the level of service required under the contract.

Receives and reviews Petitions / LWC 1008 disputed claims for compensation performs risk matter reviews and processes Petitions / LWC 1008 disputed claims for compensation to the Attorney General for legal opinions and assignment of defense counsel.

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.

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.

Participates in team and staff meetings with the Attorney Generals Office the TPA and ORM personnel to discuss strategies and defense of the case.

Performs a thorough and systematic overview of the TPAs management of workers compensation Jones Act and Employer Liability claims. Provides ongoing evaluation of TPAs claims management procedures and internal monitoring processes making recommendations for methods of improvement to reduce costs and increase efficiency.

Develops and executes periodic in-depth file reviews and performance assessments for a sufficient number of TPA claim files to confirm adjudication of claims in compliance with TPAs contract terms. Maintain documentation of performance assessment.

Works directly with other State departments/agencies that assist with the claims process such as the Office of the Attorney General and the Commissioner of Administration.

Participates as a voting member of the claims council which authorizes claims settlements up to a limit of $5000000.

Responsible for overseeing the process necessary to report and track judgments/settlements requiring legislative appropriation for payment. Organizes and makes readily available information to complete the bi-annual report to the Legislature capturing the fiscal impact.

Reviews and responds to activities of the TPAs desk examiners that require Supervisor authorization (or denial of request) to proceed including:
- Settlements and payments over $25000 - Supervisor has independent approval authority to approve settlements and payments up to $150000.
- Reserve increases over $250000 threshold - Supervisor has independent approval authority for reserves up to $500000.
- Attorney contract amendment requests - Supervisor has independent approval authority for such requests up to $250000.
- Claim denials recommended by the examiner - Supervisor considers action to override or reverse a denial when warranted.
- Requests for the retention of experts and other professional services.

Researches identifies and works in partnership with the TPA to resolve causes of errors and assists in implementing procedures to prevent their future recurrence. This function includes but is not limited to ensuring that qualified claims are submitted to the subrogation unit for potential recovery when applicable. Reviews files for potential approval and recovery from the Second Injury Board where applicable. Reviews file reserves for reasonableness accuracy and timeliness adequately reflecting the States liability exposure.

Engages in joint projects with the loss prevention unit and the underwriting section coordinating the activities of co-workers and TPA to address and resolve special problems in specific agencies and departments which have produced or could result in personal injury and/or property damage.

Assists individuals and state agencies with claim filing procedures coverage questions and Transitional Duty Employment. This process involves meetings with agency personnel the TPA and ORM staff. Statewide travel for meetings and training sessions is required.

Collaborates in the development of training topics and participates in training meetings with the TPA claim examiners/adjusters. Assist with agency training programs.

Makes recommendations and participates in the development of policies and procedures for ORM.

Assists in drafting legislation to modify and improve the self-insurance program. Evaluates proposed legislation to assess the fiscal and functional impact on the self-insurance program and the overall fiscal condition of the state.

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: