Workers Compensation Program Analyst II

Company Description The State of California Department of General Services prides itself in its vission of Excellence in the Business of Government! Come join a team that creates: A collaborative team atmosphere founded upon ethics, integrity, and stewardship. A positive work environment that is open to change and invites its workforce to challenge processes. An opportunity for individuals to utilize their knowledge, skills, and experience to grow within the department. Under the direction of the Supervisor l, the Analyst II independently performs the more varied and complex analytical insurance and workers compensation claims activities in conjunction with Department of General Services(DGS) offices, California Department of Social Services (CDSS), State departments and counties of California and third party claims administrators(TPA) in managing insurance procurement, consulting, worker’s compensation claims and provides contracted services to the CDSS in performing oversight, coordination and management of the delivery of workers compensation benefits for CDSS’ In-Home Supportive Services, CalWorks and CalFresh programs. This position is Limited Term (12 months); it may become permanent, be extended up to 24 months, or be cancelled at any time. This position is designated under the Conflict of Interest Code. The position is responsible for making or participating in the making of governmental decisions that may potentially have a material effect on personal financial interests. The appointee is required to complete Form 700 within 30 days of appointment and once per year. Department Website: https://www.dgs.ca.gov/dgs/home.aspx and https://calcareers.ca.gov/CalHrPublic/Jobs/JobPosting.aspx?JobControlId=524295

• Role Description Under the direction of the Supervisor I, the Analyst II independently performs the more varied and complex analytical insurance and workers compensation claims activities in conjunction with Department of General Services (DGS) offices, California Department of Social Services (COSS), State departments and counties of California and third-party claims administrators (TPA) in managing insurance procurement, consulting, worker's compensation claims and provides contracted services to the COSS in performing oversight, coordination and management of the delivery of workers compensation benefits for COSS' In-Home Supportive Services, CalWorks and CalFresh programs. Reviews, evaluate, and monitors claim handling activities and special request (surveillance, subrogation, nurse case management, settlement authority etc.) by conducting advanced detailed claim analysis (medical, reserves, action plans etc.), audits files and coordinates with claims administrator(s) to ensure claims are actively handled, activities and request are reasonable and in compliance with established service level agreements, labor and insurance codes. Provides advanced analysis of insurance certificates, endorsements, and contract requirements to ensure compliance with laws, regulations, and risk management standards; identifies coverage gaps, recommends corrective actions, and guides client agencies through complex insurance issues. Oversees procurement and administration of specialized insurance policies by maintaining accurate program records, validating coverage and premium calculations, and coordinating invoicing and refunds. Prepares monthly billing files, develops revenue projections, and produces executive-level reports to support strategic planning, fiscal oversight, and effective statewide insurance program operations. Independently reviews, monitors and manages workers compensation claims by communicating with affected parties, program managers, SCIF and appropriate Office of Human Resources' units to gather and analyze information and pertinent documentation and documents claim actions utilizing claims systems, knowledge of industry methodologies and best practices for risk mitigation for all parties. Works proactively to coordinate claim actions and settlement strategies to facilitate early resolution of claims. Develops complex insurance solicitations and agreements for the selection of insurance brokers and services by preparing statement of work, contractor requirements, administrative requirements, scheduling bidders conferences and participates in awarding and executing agreements in accordance with state contracting laws. Will attend administrative hearings at the WCAB, CalHR meetings, RTW roundtables, risk management groups, committees, organizations etc. as a departmental representative and conducts workers compensation training for managers and supervisors as needed, and coordinates with claims administrator to facilitate training to client agency representatives by researching new legislation, applicable laws and regulations and developing/updating training content to communicate changes, properly train all stakeholders and ensure departmental policies and procedures are updated and staff are in compliance with laws, rules and regulations. Provides backup and support for all units within ORIM; Government Claims Program, Insurance Procurement and Risk, Motor Vehicle Insurance Account, and other program, project and administrative functions within ORIM.