Job & Business Opportunities

Job Summary

This classification is primarily responsible for performing a variety tasks in the following areas: Recovery Claims; General Liability Claims; Workers’ Compensation Administration; Program, Policy, and Procedure Review, Analysis, and Support; Document and Correspondence Preparation; and Information Tracking and Reporting. This is the entry-level classification in this series, and is typically the trainee level. Work mainly involves the review of information, including summarization, analysis, interpretation and re-presentation in a different format.

Supervision

This class works under general supervision, wherein the assigned duties require the exercise of judgment or choice among pre-established actions, sometimes without clear precedents and with concern for the consequences of the action. The employee may or may not work in close proximity to his/her supervisor.

This class does not supervise.

Distinguishing Characteristics

N/A

Essential Functions

A. Recovery Claims
Duties may include:
Review all claims as assigned to determine liability. Investigate claims for
potential recovery. Communicate with responsible parties via telephone, US mail, e-mail, or facsimile. Monitor claims for status of payment. Review, edit, copy, and store surveillance videos as needed to support claim. Attend small claims court sessions as warranted. Other duties as assigned.

B. General Liability Claims
Duties may include:
Review all claims as assigned to assess liability. Develop a plan of action to thoroughly investigate claims. As needed, photograph alleged damaged vehicles or buses. Communicate with claimants, District personnel, and other parties involved via telephone, US mail, e-mail, or facsimile. Complete check requests for payment on accepted claims. Anticipate six-month statute and close files on rejected claims. Attend small claims court sessions as necessary. Other duties as assigned.
Claims Analyst I


C. Workers’ Compensation Administration
Duties may include:
Make initial contact whenever an employee sustains injury. Intake and authorize initial medical treatment, and forward all correspondence to Third Party Administrator. Input employer's report of injury and illness directly into Third Party Administrator's online program upon receipt. Make recommendations to Third Party Administrator regarding decision to accept, delay, or deny claim pursuant to the labor code. Communicate with injured employees, Third Party Administrator, defense attorney, and District personnel. Review all incoming correspondence; respond to questions and requests as warranted. Promptly report employee disability status to Third Party Administrator to ensure timely benefit payments, if applicable. Review, explain, and make recommendations to supervisor regarding settlement authorization requests. Give authorization to Third Party Administrator. Meet with Third Party Administrator, defense attorneys, and medical providers to discuss medical treatment and defense strategy. Schedule and organize meetings involving Third Party Administrator, defense attorneys, medical providers, and internal departments. Other duties as assigned.

D. Program, Policy, and Procedure Review, Analysis, and Support
Duties may include:
Interpret, analyze, and recommend changes to the light duty program. Monitor employees participating in the light duty program. Report status to Third Party Administrator. Communicate with other departments for potential placement of employees. Explain the benefits of light duty to other departments. Research policy and procedures regarding light duty with other companies. Track all employees placed on light duty. Give an oral presentation during an interactive process with qualifying employees. Make recommendations on job placement or separation, as warranted. Other duties as assigned.

E. Document and Correspondence Preparation
Duties may include:
Create, edit, and distribute documents and reports related to various claims administration. Other duties as assigned.
F. Information Tracking and Reporting
Duties may include:
Create, organize, and store hard copies of Workers' Compensation claims. File mail correspondence in existing Workers’ Compensation claim files. Summarize and tally reported Workers’ Compensation expense detail and forward to Finance for processing. Review and prepare document for contractual Workers’ Compensation management fees. Copy and forward Workers’ Compensation reports internally as requested. Maintain, interpret, and store all Workers’ Compensation reports. Create, edit, and run queries within current software. Other duties as assigned.

Job Demands

Physical and Mental Requirements:
(1) Mobility: frequent use of keyboard; frequent sitting for long periods of time; occasional bending or squatting. (2) Lifting: frequently up to 10 pounds; occasionally up to 25 pounds. (3) Vision: constant use of overall vision; frequent reading and close-up work; occasional color and depth vision. (4) Dexterity: frequent repetitive motion; frequent writing; frequent grasping, holding, and reaching. (5) Hearing/Talking: frequent hearing and talking, in person and on the phone. (6) Emotional/Psychological: frequent decision-making and concentration; frequent public and/or coworker contact; occasional working alone. (7) Environmental: frequent exposure to noise.

Knowledge and Abilities

Required Knowledge of:
Intermediate statistical analysis.
Methods and techniques of tracking, recording, and presenting statistical data.
Practical application of computers and peripheral equipment.
English grammar, punctuation, spelling, and usage.
General methods of tactful public communication.
Rail operations as mandated by the Public Utilities Commission.
Video dubbing and still frame editing.
Vehicle code, government tort claims act, and labor code.
Workers' Compensation case law.
Terminology as it relates to Workers’ Compensation.

Required Ability to:
Prioritize and deal with conflicting workload requirements.
Handle all internal and external contacts with courtesy, diplomacy, and tact.
Read, analyze, and interpret District policies, professional journals, technical publications, and government regulations.
Write reports, business correspondence, and procedure manuals.
Effectively present information and respond to questions from groups, managers, customers, and the general public.
Deal with difficult people and situations.
Learn District and departmental operating policies and procedures.
Learn departmental systems and methods.
Learn department-specific tasks and procedures.
Speak clearly and communicate messages to appropriate individuals.
Organize information clearly and precisely.
Perform intermediate mathematical calculations, including ratios and
percentages.
Apply customer service skills, representing the District in a positive way while working with the public.
Learn SAP system processes related to department and job.
Extract statistics and written information from reports and transfer to other
documents.
Explain information to others.
Work well with others.

Required Computer Skills with:
Common word processing software.
Common spreadsheet software.
Common database applications.
Accounting or operations software functionality.
Email, contact management, and scheduling software.
Presentation software.

Minimum Qualifications — Any combination of education and experience that would likely provide the required knowledge and abilities is qualifying. A typical way to obtain the knowledge and abilities would be:

Required Prior Experience
One year of technical or professional experience in claims processing or Workers’ Compensation administration.

Required Education
A bachelor’s degree in business administration or closely related field. Six years of additional qualifying experience may substitute for the education requirement.