Workers' Compensation Risk Analyst

County of Ventura (CA)•Ventura, CA

38d

About The Position

Under the supervision of the Workers' Compensation Manager within the County Executive Office, this position oversees and monitors the administration of workers' compensation benefits by a third-party administrator (TPA) and recommends, implements, and administers policies, procedures, and programs for workers' compensation. Assists in the County's investigation and evaluation of applications for disability retirement. Provides assistance, information, and intervention to employees, departments, and the TPA in the administration of the County's workers' compensation program. Reviews and conducts audits of TPA claim files to ensure compliance with law, regulations, best practices, and contractual terms. Analyzes settlement requests to ensure accurate permanent disability rating, future liability, and value assessment. Assembles, analyzes, and disseminates data regarding insured and self-insured programs. The candidate must possess extensive experience in workers' compensation claims administration, rating permanent disability, developing case settlement recommendations, and managing regulatory reserving practices. They must demonstrate exceptional analytical abilities, excellent verbal and written communication skills, and meticulous attention to detail. Additionally, they should thrive in collaborative team settings and contribute effectively to group objectives. The ideal candidate will have proven expertise in claims and benefit administration for self-insured entities and hold a valid self-insurance certificate. They will have a thorough understanding of Labor Code provisions relevant to safety members. They will demonstrate a proven ability to work independently, effectively managing multiple projects while prioritizing competing customer needs. Additionally, the candidate will be proficient in leveraging computer technology and possess a comprehensive understanding of the multidisciplinary role of Risk Management within a county-wide environment.

Requirements

Any combination of education, training, and experience that has led to the acquisition of the required knowledge, skills, and abilities.
The required knowledge, skills, and abilities can best be demonstrated by the equivalent of a Bachelor's degree in a related field (e.g., business administration, public administration, legal studies, occupational safety, industrial relations, or human resources management) AND two (2) years' experience handling workers' compensation claims, including experience with claim evaluation, management, or adjustment, obtained in insurance companies, TPAs, self-insured organizations, government agencies, or other relevant employers.
Additional years of experience may substitute for education on a year-for-year basis.
Basic proficiency in Microsoft Excel and Word.
Experience rating permanent disability in California.
Must be willing and able to occasionally travel within the County and infrequently travel outside of the County.

Nice To Haves

Four (4) or more years' experience as a workers' compensation claims examiner or adjustor for an insurance carrier, third-party administrator, or self-administered self-insured entity.
Possession of a self-insured workers' compensation claims administration certification.
Certified Workers' Compensation Claims Professional (W.C.C.P.) or equivalent.
Experience in developing and utilizing information technology solutions and analytical tools for risk management issues.
Familiarity with Labor Code provisions (such as 4850 and 3212) specific to safety members.
Experience developing and utilizing information technology solutions and analytical tools used for risk management issues.

Responsibilities

Audits and oversees TPA claims staff to ensure adherence to laws, regulations, contractual obligations, and claims management best practices.
Assists the TPA to facilitate review and decision-making on claims.
Independently rates permanent disability to evaluate settlement recommendations of TPA claims staff and defense counsel.
Acts as ombudsman between agencies, claimants, TPA, insurance carriers, and regulatory agencies.
Conducts periodic reviews and audits with County agencies, TPA staff, and insurance carriers.
Oversees the provision of benefits and compensation by the County, TPA, and insurance carriers.
Assists TPA, defense counsel, and agencies in the investigation and litigation management of workers' compensation and disability retirement cases.
Performs and coordinates investigations, audits, and evaluations of incidents, complaints, and claims.
Prepares reports for agency directors and managers.
Monitors TPA and insurance carrier claim systems for accuracy.
Reviews, revises, designs, coordinates, implements, and administers policies and procedures.
Assembles, analyzes, validates, and correlates loss information from a variety of sources, including loss runs from insurance carriers, County resources, and agency records.
Provides information and training to County personnel.
Assists direct manager and senior leaders within Risk Management, as required.

Benefits

Educational Incentive for completion of: 2.5% for an associate degree, 3.5% for a bachelor's degree, or 5% for a master's degree.
Annual Leave Redemption: The option to cash out up to 100 hours of Annual Leave accrued per year.
Deferred Compensation: Section 457 Plan and/or 401(k) Shared Savings Plan with up to a 3% match on your 401(k) contributions.
Health Plans: You are afforded a flexible credit allowance of up to $25,558 annually for purchasing medical, dental, and/or vision insurance from a group of authorized plans.
Flexible Spending Accounts: Pre-tax benefit towards eligible medical, dental, and vision care expenses.
Pension Plan: Participation in the County's defined benefit plan, which has reciprocity with CalPERS.
Holidays: 11 paid days per year, which include a scheduled floating holiday.

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