POSTING NO.: 01055196
JOB TITLE: ASSISTANT DIRECTOR-CLAIMS & INVESTIGATIONS
SALARY RANGE: $101,253 - $132,894
HAY POINTS: 775
DEPT/DIV: Law Dept/Claims Bureau
SUPERVISOR: Director-Claims & Investigations
LOCATION: Jamaica, New York
HOURS OF WORK: 9:00 am - 5:30 pm (7 1/2 hours/day)
This position is eligible for telework which is currently one day per week. New hires are eligible to apply 30 days after their effective date of hire.
In conjunction with the Director of Claims, manage and administer the daily functions of the Claims Bureau, including managing personnel, engage in data development, administer various types of investigations, negotiate, or adjust claims against LIRR and/or MTA for death, personal injury and property damage as well as monitor status and manage all unassigned claims.
This position also acts as Third-Party Administrator Project Manager for MTA Stations and Force Account Liability Insurance programs and is responsible for: (1) reviewing all claims to identify all applicable insurance coverage available from project coverage or through indemnification via agreements/contracts/leases or via subrogation vs. a third-party to cover a claim or loss in full or to reduce or mitigate loss exposure; (2) prioritizing and assigning claims to Agents with specific, preliminary instructions, and setting initial reserves based upon an analysis of available facts, alleged damages, and liability assessment; (3) monitoring status and managing all unassigned Force Account FELA claims pending assignment to an Agent; (4) monitoring defense counsels’ billing, management, and defense strategy of all MTA Stations and Force Account litigation; and (5) authorizing and settling claims within the fiduciary limits set by MTA Risk Mgmt. and FMTAC.
The position ensures that all necessary and available resources are utilized, and options considered to efficiently and thoroughly investigate, process, manage, defend and/or monitor claims/incidents with a goal towards resolving, eliminating, reducing, or managing costs and/or to mitigate risk exposure.
- Assist the Director of Claims with managing the daily administrative and operational functions of the Claims Dept. Review and manage all FELA, General Liability, Excess Liability, Owner Controlled Insurance (OCIP), Contractor Controlled Insurance (CCIP), and Railroad Protective (RRP) claims, including the gathering and review of related contracts/agreements and Certificates of Insurance (COIs), for potential submission of claims to appropriate insurance carriers or issuance of a denial of claim, pending potential assignment to an Agent.
If claim is denied by appropriate insurance carrier, retain defense counsel to either commence a Declaratory Judgment Action or Third-Party Action against the appropriate insurance carrier and to defend the underlying claim.
This position also has the fiduciary authority to settle claims and execute settlement checks within the limits set by the Vice President, General Counsel & Secretary
- Conduct an initial cursory investigation of all incidental or unassigned FELA and Force Account claims by utilizing various databases including Dmitri and CorVel (all-agency claims databases) and the System Safety database for any prior claim and injury history and securing medical records for comparison to accident detail(s), as well as review of documentation from the LIRR Medical Facility for correlation, classification of status, and authorizations for medical treatment in consideration of payment approval or denial. Communicate with various departments and the Medical Facility in order to reconcile any discrepancies in accident status including participating in DADS conference calls.
- Request authorization for surveillance from Law Dept. on incidents where there appears to be malingering and/or potential fraud. Act as Surveillance Project Manager by creating and maintaining Excel Surveillance Log and issuing Notices to Proceed to third-party investigators authorizing surveillance or other investigative activities and coordinating the prompt payment of invoices.
- Review and assign incidental FELA claims or property damage claims to Agents for investigation with specific, preliminary instructions which may include a possible home visit or the scheduling of union appointments and setting initial reserves and making subsequent adjustments based upon an analysis of available facts, alleged damages and liability information. Create and maintain Excel Home Visit Log in compliance with PERS Indicators.
- Review and evaluate requests for settlement authority and provide approval within fiduciary limits set by Vice President, General Counsel & Secretary.
- Act as Third-Party Administrator (TPA) Project Manager for all MTA Station Maintenance and Force Account claims including performing initial cursory investigation of Dmitri database, accident reports and/or Notices of Claim. Also, administer and monitor DMV searches on all claimants and for LIRR subrogation claims through NYS Department of Motor Vehicles database to obtain driver’s license history, address checks, and vehicle ownership as an authorized liaison to access such records.
- Assign claims to Agents with specific, preliminary instructions and set initial reserves and make subsequent adjustments based upon an analysis of available facts, alleged damages and liability information. Monitor status of non-litigation claims by conducting file reviews and providing additional instructions and/or recommendations for potential resolutions. Review all written requests for claim settlement authority from Agents and the corresponding claims file in order to provide settlement authority within fiduciary limits as set by MTA Risk Mgmt. and/or FMTAC, make recommendation to Director of Claims for settlement authority, or to provide instruction for further investigation that may be necessary.
- Provide recommendation to LIRR Deputy General Counsel – Torts & Administration as to assignment of internal or external defense counsel on all MTA Station Maintenance and Force Account claims based upon historical data relating to either a claimant, location, comparable incident, etc. Retain defense counsel to defend LIRR and/or MTA. Monitor and obtain status updates from assigned Agents and defense counsel to ensure that a thorough investigation is being performed and to adjust reserves if necessary. Engage in direct settlement discussions with a claimant’s/plaintiff’s attorney when necessary. Review Pre-Trial reports from defense counsel and the corresponding claim file in order to prepare an evaluation and/or recommendation to Director of Claims for settlement authority; to provide additional investigative instructions for the assigned Agent; and/or consult with defense counsel as to any additional action or strategy. Participate in conferences for trial risk assessment with LIRR General Counsel, Deputy General Counsel, defense trial counsel, MTA Director of Risk Mgmt., LIRR Director of Claims, and the assigned Agent to discuss trial strategy including strengths and weaknesses of liability, potential jury verdict vs. settlement offers. Evaluate and arrange for any specialized consultants and/or expert witnesses to assist defense counsel at trial. Review General Releases, Stipulations of Discontinuance, any Medicare or other lien reimbursements, and other closing documents for settled lawsuits and execution of settlement checks as an authorized fiduciary of the company and FMTAC.
- Review all defense counsel invoice approvals and corresponding billing invoices to obtain a snapshot of the status of litigation, execute checks in payment thereof as an authorized fiduciary of the company and FMTAC, and review and/or adjust legal expense reserves in Dmitri database.
- Participate in monthly tort/claims status conferences with General Counsel, Deputy General Counsel and Director of Claims to discuss status of claims of significant risk exposure and upcoming trial calendar.
- Review court decisions for information that may affect future claim/litigation strategies. Check status of litigation defended by LIRR Law Dept. in Law Trac database.
- Assist other LIRR departments by assigning for investigation any suspected theft of time or possible fraud or abuse of FMLA or Sick Leave policies. Provide findings to requesting department and trial offices for any appropriate disciplinary action.
- Assist other LIRR departments in attempting to recover property and other damages caused by third parties by assigning for investigation and possibly retaining defense counsel to commence subrogation or litigation.
- Assist in the facilitation of System Safety investigations by instructing Agents to provide claim investigation results within the confines of legal privileged confidentiality.
- Assist New York State District Attorney’s Office in prosecuting criminal charges occurring on LIRR property, i.e., fare-beaters, vandals, thefts, assault, etc. Act as liaison between the Claims Dept. and contractors/vendor; namely, CorVel, RSG, ISO Claim Search, AIMES, Surveillance Investigators, etc.
- Attend all-agency MTA meetings, conferences, seminars and stewardship meetings hosted by vendors; e.g., CorVel, RSG; to assist in the development of their respective databases; i.e., Care MC and Dmitri, and to analyze compiled historical data on types of employee injuries, amounts paid for medical treatment, amounts paid for lost wages due to on-the-job injuries, claims data for both employee and non-employee claimants, including locations of accidents, injuries alleged, dispositions, payments made, etc.
- Assist Director of Claims in interviewing, training, developing and supervising Agents and TPA Manager-Administration Claims. Provide guidance, support and instruction to Agents and staff. Encourage and commend personal, thoughtful suggestions and performance. Conduct file and performance reviews of staff and motivate by providing positive feedback and as well as train and develop by providing instructions and or recommendations.
- Other duties as assigned.
KNOWLEDGE, SKILLS, AND ABILITIES
- Must possess progressively responsible recent related claims and/or legal experience including extensive knowledge of FELA, Public Authorities and No-Fault laws/legal concepts as well as various lines of insurance business including General Liability; Owners’ Controlled Insurance (OCIP); Contractor’s Controlled Insurance (CCIP); Railroad Protective Insurance; Excess Liability; No-Fault. Must have knowledge of railroad operations; applicable rules and regulations; corporate policies and procedures; and union agreements as they pertain to FELA claims.
- Must have experience with claims research data collection methods including investigative experience and familiarity with the ISO System and Lexis Nexis databases.
- Must have experience managing a staff and budget.
- Must have knowledge of anatomy and medical terminology and understanding of physical and psychological trauma. Must be proficient in preparing detailed reports based upon an analysis and evaluation of compiled investigative and legal data.
- Excellent communication and interpersonal skills.
- Excellent organizational and presentation skills.
- Demonstrated ability to work with all internal levels within a given organization, including the MTA Board.
- Demonstrated ability to communicate and interact well with external agencies. External agencies may include the Governor’s Office for New York State, New York City government, elected and other public officials, as well as any staff located at other federal or state agencies or authorities.
- Demonstrated ability to work in a high profile, high pressure environment effectively.
- Demonstrated ability to communicate effectively with key internal and/or external stakeholders.
- Must have strong managerial skills to effectively direct a staff of professional and technical employees in implementing the short- and long-term goals and direction for the area of responsibility.
- Demonstrated ability to complete short- and long-term projects effectively and as efficiently as possible.
- Demonstrated analytical capabilities and quantitative skills.
- Demonstrated proficiency in Microsoft Office Suite or comparable applications, i.e., Word, Excel, PowerPoint, and Outlook.
EDUCATION AND EXPERIENCE:
- Must possess a Bachelor’s Degree in Business Management or related field of study, or an equivalent combination of education and experience from an accredited college may be considered in lieu of a degree. Demonstrated, directly related, equivalent experience and education may be considered in lieu of degree, with approval.
- Minimum 8 years related experience, including at least 4 years in a managerial and/or leadership role in a large, multi-faceted, fast-paced organization or governmental body preferred.
- Must obtain RWP certification.
- Current continuing education courses in insurance law, casualty claims law, management or similar areas is required.
- Must possess a New York State Independent Casualty Adjuster’s License requiring renewal every two years.
- Master’s degree in a related field.
- Attainment of or in the process of attaining specific functional licenses or certifications in area of specialty if applicable.
- Attainment of or in the process of attaining P.E. license from New York State.
- Familiarity with the MTA’s policies and procedures.
- Familiarity with the MTA’s collective bargaining procedures.
Pursuant to the New York State Public Officers Law & the MTA Code of Ethics, all employees who hold a policymaking position must file an Annual Statement of Financial Disclosure (FDS) with the NYS Commission on Ethics and Lobbying in Government (the “Commission”).
Equal Employment Opportunity
MTA and its subsidiary and affiliated agencies are Equal Opportunity Employers, including with respect to veteran status and individuals with disabilities.
The MTA encourages qualified applicants from diverse backgrounds, experiences, and abilities, including military service members, to apply.