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Insurance Coverage Officer (#MACH01)
$44,755.00 Yearly Min / $55,944.00 Yearly Mid / $67,133.00 Yearly Max


Insurance Coverage Supervisor (#MACH02)
$51,242.00 Yearly Min / $64,053.00 Yearly Mid / $76,864.00 Yearly Max


Insurance Coverage Administrator (#MACH03)
$62,776.00 Yearly Min / $78,470.00 Yearly Mid / $94,164.00 Yearly Max




Description of Occupational Work

This class series uses three levels in the Administrative Services occupational group, Human Resources Management occupational series and insurance coverage work by providing support to state agencies, school districts and higher education regarding State insurance programs such as workers’ compensation and property and casualty insurance.  

Essential Functions

Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class.  Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
  • Provides for fair and equitable adjustment of all insurance claims.
     
  • Mediates disputes and negotiates claim settlements.
     
  • Makes proper determination of coverage, legal liability and damages to effect settlement of claims.  
      
  • Directs contracted appraisers, investigators, rehabilitation specialists, adjusters and attorneys.
     
  • Prepares RFP's for insurance coverage and other contracted services.
     
  • Prepares interrogatives for court cases and arbitration hearings.
     
  • Researches federal and state statutes and regulations and keeps abreast of new and/or revised pending legislation for potential impact on the State.
     
  • Maintains records and reports of the self-insurance fund.

Levels of Work

Insurance Coverage Officer

This is the first level of insurance coverage work.

  • Reports to a technical supervisor.
  • Performs the full range of Essential Functions.  
  • Contacts include providing technical guidance, direction and instruction to appraisers, investigators, rehabilitation specialists, adjusters, attorneys, third party administrators, state agencies, public education, higher education and the public in order to interpret, explain and apply applicable laws, rules, regulations, programs, policy and procedures. 

Insurance Coverage Supervisor

This is the supervisory level of insurance coverage work responsible for managing day to day claims operations in the Insurance Coverage Office. 

  • Reports to a technical supervisor.
  • Supervision is exercised over at least two or more merit full time positions per the merit rules. The elements of supervision include planning, assigning, reviewing, evaluating, coaching, training, recommending hire/fire and discipline.
  • Oversees the State’s claim system and claim litigation processes from inception to conclusion, and manages the settlement of all claims and suits within area of expertise.
  • Evaluates and analyzes new or revised laws, rules, regulations, policies, programs and procedures; evaluates proposed legislation, court decisions and emerging trends in claims litigation to monitor the state’s compliance with the Unfair Claims Practice Act.   Recommends proposed changes.  
  • Participates in establishing strategic plans including operational needs and organizational priorities, long and short term goals and objectives.
  • Identifies and manages claim subrogation opportunities for the State including investigation, resolution, and collection on claims.  Works with the Department of Justice (DOJ) to analyze grounds for possible legal proceedings on these claims. 
  • Ensures adequate resources/monies are available to adjudicate claims.
  • Assists in developing the agency’s budget and contracts.
  • Contacts include providing technical guidance, direction and instruction to subordinates, appraisers, investigators, rehabilitation specialists, adjusters, attorneys, third party administrators, state agencies, public education, higher education and the public in order to interpret, explain and apply applicable laws, rules, regulations, programs, policy and procedures.

Insurance Coverage Administrator

This is the administrative management level responsible for planning and directing the operations in the Insurance Coverage Office.

  • Reports to an administrative supervisor.
  • Manages, directly and through subordinate supervisors, professional, paraprofessional and contractual personnel.  
  • Reviews, evaluates and analyzes proposed and newly enacted laws and advises supervisor of feasibility of implementation and impact on current laws, rules, regulations, programs, policies, procedures and operations. 
  • Develops, evaluates and implements new or revised programs, policies, procedures, goals and objectives to ensure compliance of state and federal requirements.
  • Establishes strategic plans including operational needs and organizational priorities, long and short term goals and objectives.
  • Manages the safety and risk management program which ranges from providing safety training programs to fit an agencies needs to property risk assessment evaluations and services.  
  • Develops and administers the agency’s budget and contracts.
  • Contacts include subordinates, appraisers, investigators, rehabilitation specialists, adjusters, attorneys, third party administrators, state agencies, public education, higher education and the public to resolve problems, interpret and explain laws, rules, regulations, policies, procedures and programs and ensure compliance with goals, objectives and state and federal requirements.  

Knowledge, Skills and Abilities

The intent of the listed knowledge, skills and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.
  • Knowledge of workers’ compensation statutory law, case law and Industrial Accident Board rules and regulations.
  • Knowledge of motor vehicle insurance statutory and case law.
  • Knowledge of Insurance Department regulations and bulletins.
  • Knowledge of state bidding laws.
  • Knowledge of property and casualty insurance underwriting, rating techniques, insurance contracts, policies and premium auditing and claims procedures.
  • Knowledge of State and carrier reimbursement programs.
  • Knowledge of legal terminology and procedures.
  • Knowledge of medical terminology, prognosis, diagnosis and treatment as applies to traumatic insurance claims.
  • Skill in communicating effectively. 
  • Skill in negotiating claim settlements.
  • Skill in investigating loss/accident claims.
  • Skill in preparation of bid specifications.
  • Ability to direct activities of contract professionals.
  • Ability to administer statewide insurance programs.
  • Ability to coordinate activities on a statewide basis with other agencies and authorities.
  • Ability to establish and maintain effective working relationships with a variety of people. 

In addition to the above knowledge, skills and abilities, the Insurance Coverage Supervisor requires:

  • Knowledge of the principles and practices of supervision.
  • Knowledge of budget and contract preparation.
  • Skill in evaluating and analyzing laws, rules, regulations, programs, policies, procedures and operations.
  • Skill in interpreting and explaining laws, rules, regulations, programs, policies and procedures.
  • Ability to assess operations, resources, programs, policies and procedures, identify problems/needs and make recommendations.

In addition to the above knowledge, skills and abilities, the Insurance Coverage Administrator requires:

  • Knowledge of the principles and practices of administration and management.
  • Knowledge of the principles and practices of budget and contract administration.
  • Knowledge of safety and risk management program. 
  • Skill in the principles and practices of supervision.
  • Skill in the principles and practices of budget preparation, analysis and control.
  • Skill in contract preparation, negotiations, and control.
  • Skill in directing and overseeing insurance coverage programs to accomplish goals and objectives.
  • Ability to analyze operational needs and implement effective solutions.

Job Requirements

JOB REQUIREMENTS for Insurance Coverage Administrator
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

  1. Possession of a Delaware Insurance Adjuster's License in two or more of the following lines of authority: Casualty, Motor Vehicle, Workers Compensation, or Property.
  2. Three years experience in ensuring compliance with laws, rules, regulations, standards, policies and procedures related to workers compensation, property, casualty or motor vehicle insurance.     
  3. Six months experience in insurance coverage program administration which includes overseeing and directing the development, implementation and evaluation of insurance coverage programs and services; planning and establishing short and long range program goals and objectives. Providing advice to other agency organizational units through consultation.
  4. Knowledge of budget management and control which includes managing a budget for the purpose of keeping expenditures within the limitations of available appropriations and available revenue and maintaining, monitoring, projecting and controlling a budget within set policies and procedures
  5. Knowledge of operations management which includes planning, directing, coordinating, controlling and evaluating operations typically through subordinate supervisors.

CLASS:
MACH01
EST:
12/5/2014
REV:
FORMERLY JOB CLASS:
MACZ03

CLASS:
MACH02
EST:
1/1/2014
REV:

CLASS:
MACH03
EST:
1/1/2014
REV: