STATE RISK ADJUSTER 1

About This Job

The Patient's Compensation Fund (PCF) was created in 1975 to provide an affordable and guaranteed medical malpractice coverage system for the private healthcare providers in the state. The Patient's Compensation Fund is self-funded state entity, operating independently of the main state budget, and governed by the PCF Oversight Board. The Patient's Compensation Fund provides protection for the healthcare system, keeping costs down, and providing a guaranteed pool of funds to pay those citizens injured from medical malpractice of private care providers. We are a small agency invested to retain a skilled, productive, engaged, diverse team that we support through training and development, building connections, and supporting a harmonious work life while delivering quality services to the citizens of Louisiana.

Incumbent will be accountable for the use of independent judgment and decision-making for driving the vision and mission of this Section. Incumbent will possess financial savvy, have strong interpersonal skills, and be results-oriented to successfully perform the daily operations required in this Section. Incumbent will maintain a high level of confidentiality, be effective in professional communication skills, and independently handle complex insurance claims pertaining to individuals injured in medical malpractice cases. Incumbent received not only specialized training in legal and medical malpractice terms for a thorough understanding of the medical malpractice process, procedure, and agency-related State statute, but additionally in the PRISM software systems specialized for PCF claims processing, settlements, and payments.

An ideal candidate will possess the following competencies : Communicating Effectively : The ability to relay information correctly and appropriately to connect people and ideas. Following Policies and Procedures : The ability to comply with policies and procedures of the organization as well as State Civil Service rules, and all applicable federal and state laws. Learning Actively : The ability to acquire necessary knowledge and skills to improve performance and achieve organizational goals. Using Data : The ability to use relevant and valid data to inform a recommendation for action. Acting with Ethics and Integrity : The ability to be consistent, honest, and a trustworthy steward of State resources. Demonstrating Accountability : The ability to accept ownership for your actions, behaviors, performance, and decisions. Managing Conflict : The ability to recognize and navigate disagreements in a rational, unbiased, and productive way. Managing Time : The ability to control your time to increase effectiveness, efficiency, or productivity. Pursuing Professional Development : A personal commitment to take advantage of opportunities to increase your professional knowledge, skills, and abilities.

Minimum Qualifications

Three 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; OR A bachelor's degree. 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.

Job Duties And Other Information

Job Duties :

• Monitor the medical review panel process, requesting updates as necessary and making all appropriate computer entries.
• Corresponds with primary insurers, defense attorneys, and outside claims adjusters to determine validity, exposure, and status of claims. Evaluate incoming medical, investigative, and discovery information to determine if the layer of primary coverage could be exceeded, referring cases of liability and / or value over $100,000 to supervisor.
• Must maintain ongoing contact with assigned future medical claimants, their caregivers, vendors and health care providers.
• Requests medical reports and bills from treating health care providers. Reviews medical reports and claim information to verify bill submitted relates to medical malpractice claim and all necessary documentation has been received.
• Processes requests for payment of related charges after determining if fees are reasonable and customary, and disallows unrelated or unnecessary charges after review of suggested cuts by a senior examiner.
• Obtains estimates for work done to modify homes and to purchase and modify vehicles for handicapped individuals.

Position-Specific Information :

Appointment Type : Full time, Classified. Probational or promotional.

Work Schedule : Monday - Friday, overtime as needed.

Compensation : Depends on the qualifications of the selected candidate. Position qualifies for premium pay.

Louisiana is a State As a Model Employer (SAME) that supports the recruitment, hiring, and retention of individuals with disabilities.

How To Apply : No Civil Service test score is required 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.

For further information about this vacancy, contact :

Taylor Colar

Patient's Compensation Fund / Human Resources

PO Box 3718

Baton Rouge, LA 70821

225-342-5200

All prospective new hires will be subject to employment eligibility verification via the federal government's E-Verify system.

As an Equal Opportunity Employer, PCF is committed to a diverse and inclusive workplace, prohibiting discrimination based on any non-merit factor. PCF is a State as a Model Employer (SAME) agency that supports improved employment opportunities for individuals with disabilities.