C# Careers in los-angeles ∙ Page 2

About the Department

Performs senior analyst-level workers' compensation functions in accordance with the California Labor Code, mentors lower level staff, and works with management and division personnel to enhance the Transitional Duty Program (TDP). This position requires the review of incoming bills for processing, medical reports, legal correspondence and handling of requests for authorization in a timely manner. Responsibilities will also include responding to incoming calls, emails, issuing timely benefit payments, and the appropriate benefit letters. Additionally, the role entails preparing files for a file reviews/roundtable with several other parties within and/or outside of Metro.

Position Duties

• Conducts senior analyst-level investigations upon receipt of new claims

• Assists employees who have been injured on the job and processes benefits due to injured employees

• Handles issues and problems regarding injured workers who have filed claims

• Processes medical bills and liens accumulated during an injured employee claim process

• Reviews and responds daily to all incoming legal and medical mail on a timely manner in accordance with California Labor Code regulations

• Handles claim files efficiently to ensure all benefits have been paid timely and appropriately

• Provides quality customer service to injured employees, division personnel, and providers

• Maintains claim files on an effective diary system to aggressively handle claims and ensure timely responses

• Works closely with legal to strategize on plans of action for appropriate resolution of claims

• Mentors and trains lower level employees

• Provides a high quantity and quality of work in accordance with departmental policies and procedures and in accordance with the California Labor Code Regulations and Requirements

• Prepares files for presentation to division personnel as required/needed

• 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

Minimum Qualifications

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 or a related field

Experience

• Three years of relevant experience handling, analyzing, and resolving workers' compensation claims and caseload of varying types of employers, including California workers' compensation laws experience

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
• California Workers' Compensation Claims Administration (WCCA) Certificate preferred
• Prior employer's Designation Certificate preferred
• California Self-Insurers Administration Certificate preferred

Preferred Qualifications

Preferred Qualifications (PQs) are used to identify relevant knowledge, skills, and abilities (KSAs) as determined by business necessity. These criteria are considered preferred qualifications and are not intended to serve as minimum requirements for the position. PQs will help support selection decisions throughout the recruitment. In addition, applicants who possess these PQs will not automatically be selected.

The following are the preferred qualifications:

• Experience in conducting full-cycle Workers' Compensation claims handling, including relevant training and any certificates obtained in this area
• Experience applying workers’ compensation labor code laws when providing benefits or denying a claim
• Experience handling the changing priorities on a Workers' Compensation claims desk on a daily basis

Other Qualifications

Knowledge of (defined as a learned body of information that is required for and applied in the performance of job tasks)

• Theories, principles and practices of claims administration
• Applicable local, state, and federal laws, rules, regulations, and guidelines governing workers' compensation, disability, and vocational rehabilitation
• State Labor Code laws
• Strategies and procedures for case settlements
• Research and report preparation
• Applicable business software applications

Skill in (defined as the proficient manual, verbal, or mental utilization of data, people, or things)

• Performing professional workers' compensation claims administration work
• Calculating wages
• Reviewing and rating medical reports
• Analyzing situations, identifying problems and issues, and recommending solutions
• Working with legal representatives to resolve matters or cases
• Working aggressively to bring cases to resolution without legal actions
• Preparing comprehensive reports and correspondence
• Communicating effectively both orally and in writing
• Operating personal computers and office equipment

Ability to (defined as a present competence to perform an observable behavior or produce an observable result)

• Organize and prioritize work
• Handle work assignments on a strict diary system to ensure deadlines are met timely
• Meet time constraints and deadlines
• Use good judgment when handling highly confidential material and information
• Follow both oral and written instructions
• Understand, interpret, and apply laws, rules, regulations, policies, procedures, guidelines, contracts, budgets, and labor/management agreements
• Compile and analyze data
• Prepare and report statistical information
• Interact professionally with various levels of employees and outside representatives
• Read, write, speak, and understand English

Special Conditions

The physical demands described are representative of those that must be met by the employee to successfully perform the essential functions of this job. Metro provides reasonable accommodation to enable individuals with disabilities to perform the essential functions.

Working Conditions

• Typical office situation
• Close exposure to computer monitors and video screen

Physical Effort Required

• Sitting at a desk or table
• Operate a telephone or other telecommunications device and communicate through the medium
• Type and use a keyboard and mouse to perform necessary computer-based functions
• Communicating through speech in the English language required