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Director - Claims and Investigations

Job ID: 5014
Business Unit: MTA Headquarters
Location: New York, NY, United States
Regular/Temporary: Regular
Department: Federal Emp Liability Act
Date Posted: Dec 21, 2023

Description

JOB TITLE:                          Director-Claims & Investigations

SALARY RANGE:               $117,785 - $154,593

DEPT/DIV:                            Law Dept/Claims Bureau

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.

SUMMARY:

Direct and oversee the management of all the functions of the Claims Bureau, including administration, accident investigation, special investigations, data development, negotiation and adjustment of claims against the Rail Road for death, personal injury and property damage. In addition, manage and administer the functions of the Claims Bureau in its capacity as the Third-Party Administrator of all claims covered by the MTA Stations and Force Account Liability Insurance program.  This includes managing the LIRR’s and other third parties litigation staff, including billing, assigned to these cases.   This position must be capable of fulfilling the contractual obligations of the Third-Party Administration function, including submission and collection of the file and handling fees from FMTAC. The position must be able to maintain the Claims Division infrastructure to compete aggressively for the renewal of the contract to ensure the continued incoming revenue of the Claims Division.  Position has authority to approve, authorize and evaluate settlements with both employees and non-employees, within the fiduciary limits set by MTA Risk Mgmt. and/or Vice President, General Counsel & Secretary.

RESPONSIBILITIES:

  • Direct and oversee the daily operations of the Claims Bureau of the LIRR Law Department. Review & assign employee and public liability claims according to complexity & effort required to ensure quality work, set initial reserves and disposition of caseload.  Review, assign and schedule union appointments to discuss and negotiate claim settlements.
  • Evaluate, approve, and authorize employee, non-passenger & third-party claim settlement amounts, within a limit set by MTA Risk Mgmt. and/or Vice President, General Counsel & Secretary. Perform annual audit of assigned claims. 
  • Establish and increase reserves of pending claims requiring an analysis of facts, damages, and liability issues. Identify claims with appropriate insurance coverage available so the matter may be referred (tendered) to insurance companies and/or contractors and other third parties.   
  • Coordinate administrative procedures internally & with departments for the preservation of physical evidence and interview of fact witnesses. Coordinate with the Medical Disability Management & Safety Dept. personnel for the proper classification of employee disability & medical treatment.
  • Identify, assign, and supervise all collection and subrogation claims. Ascertain damages, notice responsible parties & make claims for restitution.  Negotiate settlement amounts with insureds, insurance companies, attorneys, NYS Supreme Court Judges, Federal Court Judges, etc.  Approve cases for referral to the Law Dept for litigation if necessary.
  • Act as Third-party Administrator (TPA) of all Force Account & Station Maintenance, insured claims. Oversee and review Force Account and Station Maintenance claims. Retain litigation counsel. Manage handling of cases, review billing of retained counsel, approve accordingly, and arrange for payment.  Prepare billing to MTA Risk Management for Station Maintenance and Force Account claims handled by LIRR Claims Department.  Perform periodic audits of TPA claim files for accuracy and completeness of investigations as required by contract.  Grant settlement authority or write up for additional authority by MTA Risk Mgmt. and/or Vice President, General Counsel & Secretary. 
  • Intake, accept, assign & investigate internal investigation assignments from LIRR departments, such as employees’ theft of time, theft of company property and/or possible fraud (FMLA, D/A, sick leave, etc.). Provide findings to LIRR departments and trial offices for appropriate disciplinary action.  Testify and assist at disciplinary hearings/suits.   
  • Monitor, authorize & train Claims staff use of external computer systems necessary for complete claims investigations, such as Dmitri, Corvel, NYS DMV, Lexus Nexus, Accurant, ISO Claims, CHRS (Criminal History Records Search Program), etc.
  • Enable the facilitation of System Safety investigations by providing claim investigation results within the confines of legal privileged confidentiality. Confer with and assist in FRA, PTSB, PESH & NTSB investigations & audits.  Intake, confer with, assign and assist NY State Comptroller, MTA, Milliman & Consultant Audits.  Develop & foster professional relationships with all LIRR departments, MTA Risk Management, MTA Legal Department, federal, state, and local agencies such as PTSB, FRA, PESH, etc.
  • Represent the LIRR Claims Bureau by attending LIRR and/or All-agency meetings, conferences, seminars, stewardships. Run Claims data reports from Dmitri Claims System for departmental purposes, as well as information requested from LIRR departments, MTA, Consultants, etc. 
  • Participate in or designate a representative of the Claims Bureau to participate in LIRR & All-agency RFPs relating to Legal Department and Claims Bureau vendors, such as Master Insurance Broker, Investigative Services, Security Administration.
  • Develop and manage section budget. Prepare, review, analyze and approve all third-party billing. Maintain surveillance budget and review surveillance requests and reports for appropriateness.  Act as a liaison between the Law Dept, Labor Relations, Medical and the individual Departments with regard to surveillance and possible Departmental charges.   Maintain and Reconcile Subpoena Checking Account.  Issue checks as warranted.  Prepare monthly report to Treasury and General Counsel. 
  • Interview, hire, develop and motivate personnel within the department. Training & supervision of Asst. Director of Claims, Senior Claim Agents, Claim Agents, and Manager-Administration Claims. Provide career development for subordinates. Provide guidance, support, and instruction to Agents 24/7 during emergency situations/incidents.  Responsible for discipline/termination of employees when necessary. Review performance of staff.  Motivate to produce an excellent work product.  Create a professional environment that respects individual differences and enables all employees to develop and contribute to their full potential.  Lead by example.
  • Keep abreast of claims field advances & changes. Remain current in liability laws, court decisions, best practices in the insurance industry and any other issues that change or affect the way business is conducted.  Coordinate & ensure that staff training is current per company policy & FRA (Fed. Railway Administration) regulations, i.e.: Roadway Worker Protection, Defensive Driving, etc.  Licensed candidates: Study on an ongoing basis to maintain Independent Insurance Adjuster license (License renewal every 2 years).      
  • Per US Government regulations, determine if claimants are Medicare eligible. In accordance with the regulation, input, monitor & report all eligible claim settlements through the CareMC Medicare Query program.  Perform other assignments as requested by Sr. Management.
  • Act as CAP Coordinator for the Law/Claims/Diversity areas. Work with CAP Terminal Managers to assign new departmental employees to CAP teams.  Ensure all departmental CAP managers are up to date on training.  Ensure CAP attendance on assigned weeks.  Solicit volunteers for scheduled CAP events. 
  • Other duties as assigned

 

KNOWLEDGE, SKILLS, AND ABILITIES

  • Must possess progressively responsible related recent experience including extensive working knowledge of Insurance Law and coverage preferably as pertaining to a railroad or transportation business.
  • Must have working knowledge of related laws, regulations, corporate policies and procedures.
  • Must have experience with related research data collection methods and investigative experience and skills.
  • Must have experience managing a staff and budget.
  • Must have field experience and an understanding of damage trauma, anatomy and legal liability.
  • Must have knowledge of applications of labor agreements & Federal Employers Liability Act.
  • Must possess demonstrated effective management, leadership, negotiating, problems solving, decision making and judgment skills.
  • Must demonstrate a strong work ethic and professional integrity.
  • Must be able to demonstrate effective claims negotiating skills, to continue to drive down the costs of these claims.
  • 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, Law/Insurance 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.
  • Minimum 10 years related experience, including at least 4 years in a department head and/or managerial and/or leadership role in a large, multi-faceted, fast-paced organization or governmental body preferred.
  • Current continuing educations courses in insurance law, casualty claims law, management or similar areas is required. 

PREFERRED: 

  • Master’s degree in a related field.
  • New York State Independent Casualty Adjuster’s License, requiring renewal every two years.
  • 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.

     

OTHER INFORMATION:

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.

 

 

 

 

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