Risk Analyst, Senior
DEFINITION: Under general direction, leads the work of staff in
the Workers' Compensation unit of the Risk Management Office; serves
as the supervisor in the absence of the Risk Program Administrator;
acts as a technical resource to staff; investigates, evaluates, and
resolves Workers' compensation claims; and performs other related
duties as assigned.
DISTINGUISHING CHARACTERISTICS: This class serves as a lead worker
in the Risk Management Office and carries a reduced workload in
order to accommodate its leadworker duties. It is distinguished from
the Risk Analyst by its responsibility for training and directing
the workflow of the unit. The Risk Analyst, Senior is distinguished
from the Risk Program Administrator by that classification's overall
responsibility for the Workers' Compensation program, including the
responsibility for direct supervision of the Risk Analysts.
EXAMPLES OF DUTIES:
1. Acts as a lead worker for the Workers' Compensation unit; assigns
and reviews the work of Risk Analysts performing claims management
duties; identifies training needs and provides appropriate training;
coordinates daily activities of the Workers' Compensation unit in
order to ensure timely and accurate completion of all essential
functions; provides input for employee evaluations.
2. Investigates claims to determine compensability by interviewing
claimants, witnesses, and other individuals; assigns independent
adjusters to manage claims; documents file activity in the claims
management system; develops and implements a course of action to
resolve claims; obtains pertinent information to determine
compensability or extent of injuries, including police reports,
internal accident investigation forms, and medical reports.
3. Manages injured workers' medical treatment claims; obtains work
site evaluations to prevent further injury and to assist in
returning the employee to work; coordinates the claimant's return to
work with the Back-To-Work Counselor and department representative;
manages services of vocational rehabilitation vendors who provide
retraining to disabled employees.
4. Obtains evidence in contested and/or litigated claims to assist
County Counsel or outside attorneys to defend claim and to prepare
for trial; prepares for and represents the County at Workers'
Compensation Appeals Board (WCAB) and other administrative bodies;
may act as an expert witness for the County.
5. Attends review team meetings to evaluate individual cases;
communicates with assigned departments on specific claims and during
scheduled departmental meetings; establishes, reviews, and adjusts
financial reserves of claims; negotiates and settles claims within
established authority and/or negotiates and recommends settlement of
claims exceeding established authority; reviews invoices and
authorizes payments for indemnity, medical, and other charges;
investigates and pursues viable third-party subrogation; prepares
related reports, statistics, and correspondence necessary to manage
the claims process.
6. Reviews and determines the significance of new statutes,
regulations, and reported cases to determine their significance to
the County; refers departmental accident reports, duty assignments,
job descriptions, and safety practices to the County Safety Officer
for possible corrective action(s).
7. Trains and supervises paraprofessional staff.
1. Two years of professional experience investigating and resolving
employee or third-party Workers' Compensation claims as an adjuster,
examiner, or equivalent in California for a self-insured public
entity, equivalent private-sector employer, third-party
administrator, or insurance carrier; or,
2. two years of experience performing duties equivalent to a Risk
Analyst with Santa Barbara County investigating and resolving
Workers' Compensation claims; or,
3. a combination of training, education, and experience that is
equivalent to one of the employment standards listed above and that
provides the required knowledge and abilities.
Additional Qualifications: Possession of a valid California Class C
Driver's License. The California Self-Insured Administrator's
Certificate must be obtained within the first year of employment.
Knowledge of: California labor codes, case law, and regulations
pertaining to workers' compensation and vocational rehabilitation;
the principles and practices of loss control programs related to
insurable risk; claims management method and negotiation techniques;
medical and technical terminology used in industrial injury/illness
cases and in the insurance industry; standard English usage and
Ability to: analyze claims in accordance with applicable laws and
County procedures and policies; present arguments and statements of
fact in written and oral forms; exercise independent judgment in
resolving claims; learn the principles and practices of supervision
and performance management; learn training techniques and identify
training needs; plan, organize, assign, and prioritize the work of
self and others; establish and maintain working relationships with
County managers, employees, attorneys, medical personnel, and other
individuals involved in the claims process; maintain objectivity and
confidentiality; read, understand, and evaluate complex reports,
laws, and case histories; evaluate and negotiate settlements; and
prepare oral and written reports.