Sr. Workers' Compensation Claims Analyst
About The Position
Provides administrative and professional support to adjusters and supervisors within the Workers' Compensation Claims unit. The role investigates and manages workers' compensation claims, assists injured employees, processes benefits, medical bills, and liens, and works with legal staff and other stakeholders to resolve claims. It also supports compliance with California Labor Code requirements, maintains effective claim-file records and diaries, and mentors lower-level employees. The position supports the agency's mission and work values, including safety, service excellence, workforce development, fiscal responsibility, innovation and technology, sustainability, integrity, and teamwork. It also contributes to the agency's Equal Employment Opportunity policies and programs and performs other duties as assigned.
Requirements
- Three years of relevant experience handling, analyzing, and resolving workers' compensation claims and caseloads involving varying types of employers, including experience with California workers' compensation laws.
- Valid California Class C driver's license, or the ability to use an alternative method of transportation when needed to carry out job-related essential functions.
- Knowledge of claims administration theories, principles, and practices; applicable local, state, and federal laws, rules, regulations, and guidelines governing workers' compensation, disability, and vocational rehabilitation; state Labor Code laws; claim settlement strategies and procedures; research and report preparation; and applicable business software applications.
- Ability to organize and prioritize work and handle assignments using a strict diary system to meet deadlines.
- Ability to meet time constraints and deadlines.
- Ability to use good judgment when handling highly confidential material and information.
- Ability to follow oral and written instructions and understand, interpret, and apply laws, rules, regulations, policies, procedures, guidelines, contracts, budgets, and labor/management agreements.
- Ability to compile and analyze data and prepare and report statistical information.
- Ability to interact professionally with employees at various levels and outside representatives.
- Ability to read, write, speak, and understand English.
Nice To Haves
- Prior employer's Designation Certificate.
- California Self-Insurers Administration Certificate.
Responsibilities
- Conduct senior analyst-level investigations of new claims.
- Assist employees injured on the job and process benefits due to injured employees.
- Handle issues and problems involving injured workers who have filed claims.
- Process medical bills and liens accumulated during an injured employee's claim.
- Review and respond daily and promptly to incoming legal and medical mail in accordance with California Labor Code regulations.
- Manage claim files efficiently to ensure benefits are paid timely and appropriately and provide quality customer service to injured employees, division personnel, and providers.
- Maintain claim files using an effective diary system to manage claims proactively and ensure timely responses.
- Work with legal staff to develop strategies and plans of action for appropriate claim resolution.
- Mentor and train lower-level employees.
- Produce work of sufficient quantity and quality in accordance with departmental policies, procedures, and California Labor Code requirements.
- Prepare files for presentation to division personnel as needed.
- Contribute to carrying out the agency's Equal Employment Opportunity policies and programs.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
