Workers' Compensation Analyst

 

Positions at this level perform independent work adjusting Workers' Compensation Indemnity Claims, as well as assume responsibility for monitoring the timeliness and compliance requirements of all State of California forms.

 

Essential functions of the job include, but are not limited to, the following:
Contacts, interviews and advises injured employees of their Workers' Compensation benefits.
 
Enters initial claim data into a computerized database system and updates data as needed.
 
Maintains and reviews reserves for ongoing claims management.
 
Oversees the adjusting of the "medical only" claims by the workers' compensation technician.
 
Maintains and adjusts claims using a diary system.
 
Prepares files for audits by the State of California and other agencies.
 
Interacts with Third Party Administrator (TPA) regarding claims. 

Interacts with the utilization review company to assure all medical treatment provided under workers' compensation is in accordance with the Medical Treatment Utilization Schedule approved by the State of California.
 
In litigated claims, assists in the litigation process with the workers' compensation defense attorneys until case resolution.
 
In non-litigated cases, processes all settlement documents and makes limited appearances at the Workers' Compensation Appeals Board.
 
Attends monthly or quarterly claims reviews with City Departments.
 
Coordinates workers' compensation temporary disability benefits with Finance and other City Departments to ensure benefits are paid in accordance with statutory workers' compensation requirements, City policies and provisions of the Memoranda of Understanding.
 
Facilitates return-to-work process for injured workers. 
 
Reviews injury reports, performs and/or coordinates field investigation of questionable claims, and establishes reserves on medical only and indemnity files.
 
Reviews indemnity claims to determine if permanent disability exists. Completes all necessary forms and documentation required for informal disability rating; obtains settlement authority and settles claims.
 
Advises all parties of the permanent work restrictions so that the ADA interactive process is initiated. This process may include obtaining a job analysis of the injured employee's job duties for review by the workers' compensation doctor.
 
Ensures confidentiality of information and handles with discretion pursuant to HIPAA laws. 
 
Conducts related training programs and makes presentations regarding workers' compensation benefits to employees and/or supervisory personnel.
 
Ensures Department services are provided with the highest customer service and ethical standards.
 
Drives on City business as necessary.
 
Assumes responsibility for ensuring the duties of the position are performed in a safe efficient manner.

Performs other related duties as assigned or as the situation requires.

Knowledge of:
Basic mathematical operations such as addition, subtraction, multiplication and division.
English grammar usage, spelling, punctuation, and business vocabulary.
Medical and legal terminology.
Pertinent Federal and State laws, including the Americans with Disabilities Act (ADA).
Workers' Compensation benefits.
Workers' Compensation claims adjustment procedures and processes.
HIPAA laws and regulations. 
 
Skill in:
Effective oral and written communications, both on a one-on-one and a group basis.
Interpersonal interactions with individuals.
Making independent judgments and decisions based on standard policy or procedure.
Organizing and prioritizing assignments.
Use of computer applications such as Microsoft Office (Word, Excel, Outlook).
 
Ability to:
Deal calmly with rude or angry people.
Deal effectively with employees and other individuals with tact and discretion.
Develop necessary skills from on-the-job training and meet the standards of performance for the classification by the end of the probationary period.
Foster a teamwork environment and promote respect among colleagues and supervisors. 
Lead, train, and coordinate the work of others.
Maintain accuracy while handling a large caseload under strict deadline pressure.
Model and practice the highest standards of ethical conduct.
Multitask and meet deadlines as established by the State of California.
Provide exceptional customer service to the public, City employees, vendors, medical providers, and those who come in contact with Workers' Compensation.
Read, write, communicate effectively and comprehend directions in English.
Review injury reports, investigate claims, and advise employees of benefits.
Utilize a specialized computer application to maintain Workers' Compensation files.
Handle confidential information and situations with discretion.
 
Other Characteristics
Willingness to:
Assume responsibility for maintaining a safe working environment.
Plan, initiate, recommend and carry out personnel actions.
Work necessary hours and times to accomplish goals, objectives, and required tasks in a timely manner.
 
Experience
Four years of recent experience adjusting Workers' Compensation Indemnity Claims. Experience working in a public agency is highly desirable.
 
Education/Training
Graduation from high school or attainment of GED or CHSPE certificate.
Associate of Arts/Science Degree is highly desirable.
 
License(s)/Certification(s)
A valid Class C California driver's license required.
Claims Adjuster certificate pursuant to Title 10, California Code of Regulations Section 2592.02.
Must be able to obtain a minimum of 30 hours of post-designation workers' compensation training every two years as required by the State of California.
Self-Insurance Administrator's Certificate issued by the State of California.
Workers' Compensation Claims Administration (WCCA) Certificate issued by the Insurance Educational Association is highly desirable.

 

Note
An equivalent combination of experience, education and/or training may substitute for the listed minimum requirements.