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
• 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

Skills :

• 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.

PTSC BENEFITS

Medical / Dental / Vision Plan - Employee has the choice of 3 separate medical plans and 3 dental plans. A separate vision plan is included in each medical plan.

Group Life Insurance - PTSC pays for an amount equal to your annual salary, rounded up to the nearest $1,000. Minimum amount of life insurance is $30,000.

Accidental Death & Dismemberment Insurance - PTSC provides $50,000 coverage for each employee. Additional voluntary coverage in amounts up to $500,000 is available at favorable premium rates.

Long-Term Disability Insurance - 100% employer paid. Provides employees with a minimum income of 60% of earnings after six months of disability.

Buy up or buy down options available.

Holidays - 12 days a year : New Year's Day, Martin Luther King Jr. Day, Juneteenth, Cesar E. Chavez Day, Presidents' Day, Memorial Day, Independence Day, Labor Day, Veterans' Day, Thanksgiving Day, Day After Thanksgiving, and Christmas Day.

Time off with Pay (TOWP) - Compensates employees who are on approved absence from work for reasons such as illness, injury, medical and dental appointments, personal business, vacation, or observance of (a) religious holiday.

Years of Service Annual Accrual

Hire date - 5 years 20 days

Beginning of 6th - 10th year 25 days

Beginning of 11th - 15th year 30 days

Beginning of 16th + years 35 days

Pension Plan - PTSC retirement plan is the Public Employees' Retirement System (PERS). Vesting is five (5) years. Minimum retirement age is 52, based on the 2% at 62 formula.

Other Benefits : Transportation passes for employees and / or eligible dependents; Medicare; Tuition reimbursement; credit union membership;

SDI; Deferred Compensation Plan; 401(K) Thrift plan; EAP; Medical and Dependent Care Flexible Spending Accounts; Flexible work schedules; and Jury Duty Pay.