Insurance Coverage Officer (#MACH01)
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$58,719.00 Yearly Min / $73,399.00 Yearly Mid / $88,079.00 Yearly Max

Insurance Coverage Manager (#MACH02)
$66,489.00 Yearly Min / $83,111.00 Yearly Mid / $99,733.00 Yearly Max

Insurance Coverage Administrator (#MACH03)
$80,112.00 Yearly Min / $100,140.00 Yearly Mid / $120,168.00 Yearly Max

This class series uses three levels in the Administrative Services occupational group, Human Resources Management occupational series and describes insurance coverage work on behalf of the State of Delaware.  Employees in this class series ensure quality support, administration and adjudication of claims associated with the State’s insurance needs including managing insurance programs for all lines of insurance except health, life, and disability.  This includes state vehicles, buildings, and property, as well as workers’ compensation.  Work also includes reviewing and inspecting state facilities for safety issues and risk and developing and providing safety programs to State employees.

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.

• Performs coverage analysis, investigation, evaluation, negotiation, and deposition of insurance claims for all lines of insurance except health, life and disability managed and paid on behalf of the State of Delaware.  This includes conducting research, collecting data, performing investigations, mediating disputes and negotiating claim settlements when appropriate. 
• Provides expertise on behalf of the State on insurance programs and other insurance claims questions.
• Makes proper determination of coverage, legal liability, and damages to effect settlement of claims.
• Directs contracted appraisers, investigators, rehabilitation specialists, adjusters, and attorneys in adjudicating claims.
• Prepares Request For Proposals (RFPs) for insurance coverage and other contracted services.
• Researches federal and state statutes and insurance regulations and keeps abreast of new and/or revised pending legislation for potential impact on the State.
• Prepares files with required forms exhibits and reports to assist in litigation management and maintains a working diary for each assigned claim file.
• Maintains records and reports of the self-insurance fund.
• Ensures all subrogation is promptly identified, the responsible party is documented in an automated information system and subrogation letters are sent to responsible parties.

Insurance Coverage Officer
This is the full performance level of insurance coverage work providing expertise for insurance claims and insurance coverage on behalf of the State.

• Reports to a technical supervisor.
• Performs the full range of Essential Functions.
• Investigates coverage and liability of claims through telephone, correspondence, and/or personal contact with claimants, attorneys, witnesses, and others having pertinent information.  Issue applicable coverage letters.
• Analyzes information to evaluate assigned claims to determine the extent of loss in accordance with state and federal laws, rules, regulations, standards, policies, procedures, considering past decisions and precedents.
• Updates claims system on a continual basis to accurately reflect status of each assigned file.
• Evaluates, negotiates and resolves claims within delegated authority.
• Serves as a knowledgeable expert (non-managerial) providing technical guidance, and recommendations on complex inquiries, claims and other related matters, requiring the complex interpretation of state and federal laws, rules, regulations, standards, policies, procedures and considering past decisions and precedents.
• Reviews past decisions, research, and other data to identify challenges and risk, and makes recommendations to management for improvements.  
• Participates in analyzing new or revised state and federal laws, rules and insurance regulations and identifies possible impacts on the State’s insurance coverage or related policies and procedures.
• 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 to interpret, explain and apply applicable laws, rules, regulations, programs, policy, and procedures. 

Insurance Coverage Manager
This is the management level of insurance coverage work responsible for managing claims operations of the Insurance Coverage Office on behalf of the State. 

• Reports to an administrative supervisor and assumes full authority in the absence of direct 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.
• Supervises, coordinates and monitors claims activities to obtain and ensure an accurate, quality outcome.
• Oversees the State’s claim system and claim litigation process from inception to conclusion and manages the settlement of all claims and suits.
• Represents the State as a Subject Matter Expert at meetings, presentations, proceedings and/or committees and provides education to others on current and revised laws, rules, regulations, standards, policies, procedures, and best practices, as well as past precedents and determinations.
• 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 state and federal laws, rules, and insurance regulations.   Recommends proposed changes.
• Provides input at the strategic policy level by participating in establishing strategic plans including operational needs and organizational priorities, long and short-term goals and objectives, as well as policies and procedures.
• 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.
• Manages the handling and resolution of all claims within area of responsibility and authority. Manages reserve process to ensure reserve adequacy. Approves claim reserves and payments within authority and as necessary.
• 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 to interpret, explain and apply applicable laws, rules, regulations, programs, policy, and procedures. 

Insurance Coverage Administrator
This is the administrative level responsible for planning and directing the operations of the Insurance Coverage Office and for providing administrative and technical direction, guidance, and information on a Statewide basis regarding insurance coverage, policies, and procedures.

• Reports to an appointed official.
• 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 applicable to Statewide insurance programs.
• 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 including providing safety training programs to fit agency needs and risk assessment evaluations and services.
• Presents claims at mediation/arbitration hearings as needed.
• Monitors and analyzes evolving legal, medical, financial, actuarial, and economic trends and developments to provide the most beneficial and cost-effective workers’ compensation, insurance coverage and safety/risk management programs for the State.
• Conducts research, analyzes data, drafts reports and makes recommendations on related legislation, policy changes, new or revised programs and fiscal activities.
• Develops and administers the agency’s budget, including developing quarterly and annual financial, budget and expenditure forecast reporting, compiling performance metrics and describing division accomplishments.
• Administers and ensures compliance of the agency’s contracts and requests for proposals, including: evaluating and proposing recommendations to self-insure or purchase commercial policies to safeguard State assets and ensuring contracts, amendments and insurance policies are negotiated and completed before implementation or renewal data and within contractual or statutory effective dates.
• Serves as contact on audits, supplying required information and reviewing audit findings and recommendations and ensuring any necessary corrective action is implemented.
• Participates in and/or provides information to policy boards and committees such as the Delaware Workers’ Compensation Board.
• 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.  

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 , 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 researching, interpreting and explaining applicable laws, rules, regulations, standards, policies and procedures.
• Skill in providing complex technical guidance, consultation and recommendations.
• Skill in anticipating and resolving challenges and improving compliance.
• Skill in effective communications, both orally and in writing.
• Skill in negotiating claim settlements.
• Skill in investigating loss/accident claims.
• Skill in preparation of bid specifications.
• Ability to use sound judgment and reach logical conclusions.
• Ability to direct activities of contract professionals.
• Ability to coordinate insurance activities on a statewide basis with other agencies and authorities.
• Ability to establish and maintain effective working relationships with a variety of people.
• Ability to analyze new and revised laws, rules and regulations and determine impacts.
• Ability to maintain confidentiality.

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

• Knowledge of the principles and practices of management.
• Knowledge of strategic policy formulation and evaluation.
• Knowledge of developing short and long range strategic plans.
• Skill in evaluating and analyzing laws, rules, regulations, programs, policies, procedures and operations.
• Ability to assess operations, resources, programs, policies, and procedures, identify problems/needs and make recommendations.
• Ability to resolve conflict and reach consensus.
• Ability to recognize and integrate diverse and/or conflicting priorities.

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

• Knowledge of operations management which includes planning, directing, coordinating, controlling, and evaluating operations through supervisors.
• Skill in the principles and practices of budget and contract administration.
• Skill in the principles of developing safety and risk management programs. 
• Skill in administering the State’s insurance coverage operations.
• Skill in policy administration which includes developing, implementing and evaluating policies and procedures.
• Skill in assessing impacts of state and federal legislated changes on assigned area.
• Skill in managing special studies and projects, and related resources that meet the State’s mission, goals, and objectives.
• Skill in developing short and long range strategic plans.
• Skill in establishing performance measures and monitoring performance.
• Ability to analyze operational needs and implement effective solutions.
• Ability to communicate effectively with state, local and federal agencies, and various elected/appointed officials.
• Ability to exercise discretion and independent judgment with respect to matters of significance.
• Ability to develop innovative approaches to resolve complex challenges and to manage risk.  

JOB REQUIREMENTS for Insurance Coverage Officer
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 one or more of the following lines of authority: Casualty, Motor Vehicle, Workers Compensation, or Property.
2. Six months experience in investigating, evaluating and negotiating insurance claims and making determinations for coverage, legal liabilities and damages affecting the settlement of claims.
3. Three years experience in interpreting insurance laws, rules, regulations, standards, policies and procedures.
4. Six months experience in narrative report writing.
5. Knowledge of medical terminology.