Under supervision of the Deputy Executive Officer - Workers’ Compensation/Disability Management Division of Risk Management within the County Executive Office, this position oversees and monitors the administration of workers' compensation benefits by a third-party administrator (TPA). Recommends, implements, and administers policies, procedures and programs for workers' compensation. Assists in the 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. Assemble, analyze and disseminate data regarding insured and self-insured programs.
The candidate must have considerable experience as a worker's compensation professional, responsible for claims and benefit administration; to include experience rating permanent disability, developing case settlement recommendations and regulatory reserving practices. Must have superior analytical and strong oral, written communication skills with attention to detail, and be adept at working collaboratively in a team environment.
THE IDEAL CANDIDATE
The ideal candidate will possess a self-insurance certificate, and familiarity with Labor Code provisions specific to safety members. Additionally, the ideal candidate will possess the proven ability to work independently to manage multiple projects and prioritize customers' competing needs; will demonstrate the ability to harness the power of computer technology; and will understand the multidisciplinary role of Risk Management in a County-wide setting.
EXAMPLES OF DUTIES
EDUCATION, TRAINING, and EXPERIENCE
- Audit and oversee TPA claims staff to ensure adherence to law, regulations, contractual obligations and claims management best practices.
- Assist third part administrator (TPA) to facilitate review and decision making on claims.
- Independently rate permanent disability to evaluate settlement recommendations of TPA claims staff and defense counsel.
- Act as ombudsman between agencies, claimants, TPA, insurance carriers and regulatory agencies.
- Conduct periodic reviews and audits with County agencies, TPA staff and insurance carriers.
- Oversee the provision of benefits and compensation by the County, TPA and insurance carriers.
- Assist TPA, defense counsel and agencies in investigation and litigation management of worker's compensation and disability retirement cases.
- Perform and coordinate investigations, audits and evaluations of incidents, complaints and claims.
- Prepare reports for agency directors and managers.
- Monitor TPA and insurance carrier claim systems for accuracy.
- Review, revise, design, coordinate, implement and administer policies and procedures.
- Assemble, analyze, validate and correlate loss information from a variety of sources, including loss runs from the insurance carriers, County resources and agency records.
- Provide information and training to County personnel.
- Assist unit manager and Risk Manager as required.
- Any combination of education, training, and experience that has led to the acquisition of the required knowledge, skills, and abilities. This can be demonstrated by a Bachelor's degree in a related field (e.g., business, labor, law, biology or science, insurance) AND two (2) years' experience as a worker's compensation claims examiner or adjustor for an insurance carrier, TPA or self-administered self-insured entity. Additional years of experience may substitute for education on a year-for-year basis.
NECESSARY SPECIAL REQUIREMENTS
- Must possess and maintain a valid California Class "C" driver license.
- Basic proficiency in Microsoft Office Suite products such as Word, Excel, PowerPoint, etc.
- Experience rating permanent disability in California.
- Experience handling COVID-19 claims.
PHYSICAL WORK REQUIREMENTS:
- Four (4) or more years' experience as a worker's 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.
- Familiar with Labor Code provisions (such as 4850 and 3212) specific to safety members.
FINAL FILING DATE:
- Job duties are primarily within an office environment, with occasional field investigation.
- Job duties require primarily alternate sitting and standing.
- Job duties require occasional travel within the County and infrequent travel outside of the County.
This is a continuous recruitment and may close at any time; therefore, apply as soon as possible if you are interested in it. Your application must be received by County of Ventura Human Resources no later than 5:00 p.m. on the closing date.
To apply on-line, please refer to our web site at www.ventura.org/jobs. Click Workers' Compensation and Disability Retirement Risk Analyst
to be taken to the job announcement directly. If you prefer to fill out a paper application form, please call (805) 654-5129 for application materials and submit them to County of Ventura Human Resources, 800 South Victoria Avenue, L-1970, Ventura CA 93009.