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Risk Analyst, Senior

Salary: N/A

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.

EMPLOYMENT STANDARDS:

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 grammar.

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.

 



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