WORKERS' COMPENSATION ANALYST

Basic Function

Performs journey-level workers′ compensation functions in accordance with the California Labor Code and assists employees with work-related injuries return to work and assume their customary duties or to Transitional Duty.

Example Of Duties

• Conducts journey-level investigations upon receipt of new claims
• Reviews and responds to all incoming legal and medical mail on a timely manner in accordance with California Labor Code regulations
• Audits claim files to ensure all benefits have been paid appropriately
• Provides timely and quality customer service to all Metro staff as well as outside providers
• Maintains close working contact with injured employees and division personnel
• Maintains claim files on an effective diary system
• Meets with division personnel on a quarterly basis to review open Workers′ Compensation cases
• Works closely with legal to strategize on appropriate handling of claims
• Contributes to ensuring that the Equal Employment Opportunity (EEO) policies and programs of Metro are carried out
  

  
  May be required to perform other related job duties

Requirements For Employment

A combination of education and/or experience that provides the required knowledge, skills, and abilities to perform the essential functions of the position. Additional experience, as outlined below, may be substituted for required education on a year-for-year basis. A typical combination includes:

Education

• Bachelor's Degree in Business Administration, Human Resources, or a related field

Experience

• One year of relevant experience examining California Workers' Compensation indemnity claims or related experience in the workers′ compensation industry

Certifications/Licenses/Special Requirements

• A valid California Class C Driver License or the ability to utilize an alternative method of transportation when needed to carry out job-related essential functions

• An Insurance Education Association Certificate and California Workers' Compensation Self-Insured Certificate preferred

• Prior employers′ designation Certificate required in claims handling

Knowledge:

• Theories, principles, and practices of workers' compensation claims administration

• California State Labor Code and other applicable laws, rules, and regulations governing workers' compensation

• American Medical Association Guidelines

• Permanent Disability Ratings

• Applicable business software applications

• Performing professional workers' compensation claims administration work

• Calculating wages

• Analyzing situations, identifying problems and issues, and recommending solutions

• Exercising sound judgment when faced with complex issues

• Communicating effectively verbally and in writing

• Interacting professionally with various levels of Metro employees and outside representatives

• Conducting and reporting outcomes of roundtable sessions to discuss cases

Abilities:

• Read and interpret legal reports

• Review and rate medical reports

• Work with legal representatives to resolve matters or cases

• Work aggressively to bring cases to resolution without legal actions

• Handle work assignments and meet time constraints on a strict diary system to ensure deadlines are met

• Organize and prioritize work

• Compile, analyze, and prepare comprehensive management reports

• Use good judgment when handling highly confidential information

• Understand, interpret, and apply laws, rules, regulations, policies, procedures, contracts, budgets, and labor/management agreements

• Travel to offsite locations

• Read, write, speak, and understand English

Selection Procedure

Applicants who best meet job-related qualifications will be invited to participate in the examination process that may consist of any combination of written, performance, or oral appraisal to further evaluate job-related experience, knowledge, skills and abilities.