Performs journey-level workers′ compensation functions in accordance with the California Labor Code and assists employees with work-related injuries return to work and assume their customary duties or to Transitional Duty.

• Conducts journey-level investigations upon receipt of new claims

• Reviews and responds to all incoming legal and medical mail on a timely manner in accordance with California Labor Code regulations

• Audits claim files to ensure all benefits have been paid appropriately

• Provides timely and quality customer service to all Metro staff as well as outside providers

• Maintains close working contact with injured employees and division personnel

• Maintains claim files on an effective diary system

• Meets with division personnel on a quarterly basis to review open Workers′ Compensation cases

• Works closely with legal to strategize on appropriate handling of claims

• Contributes to ensuring that the Equal Employment Opportunity (EEO) policies and programs of Metro are carried out

  
  May be required to perform other related job duties

Knowledge of (defined as a learned body of information that is required for and applied in the performance of job tasks)

• Theories, principles, and practices of workers' compensation claims administration

• California State Labor Code and other applicable laws, rules, and regulations governing workers' compensation

• American Medical Association Guidelines

• Permanent Disability Ratings

• Applicable business software applications

Skill in (defined as the proficient manual, verbal, or mental utilization of data, people, or things)

• Performing professional workers' compensation claims administration work

• Calculating wages

• Analyzing situations, identifying problems and issues, and recommending solutions

• Exercising sound judgment when faced with complex issues

• Communicating effectively verbally and in writing

• Interacting professionally with various levels of Metro employees and outside representatives

• Conducting and reporting outcomes of roundtable sessions to discuss cases

Ability to (defined as a present competence to perform an observable behavior or produce an observable result)

• Read and interpret legal reports

• Review and rate medical reports

• Work with legal representatives to resolve matters or cases

• Work aggressively to bring cases to resolution without legal actions

• Handle work assignments and meet time constraints on a strict diary system to ensure deadlines are met

• Organize and prioritize work

• Compile, analyze, and prepare comprehensive management reports

• Use good judgment when handling highly confidential information

• Understand, interpret, and apply laws, rules, regulations, policies, procedures, contracts, budgets, and labor/management agreements

• Travel to offsite locations

• Read, write, speak, and understand English

A combination of education and/or experience that provides the required knowledge, skills, and abilities to perform the essential functions of the position. Additional experience, as outlined below, may be substituted for required education on a year-for-year basis. A typical combination includes:

Education

• Bachelor's Degree in Business Administration, Human Resources, or a related field

Experience

• One year of relevant experience examining California Workers' Compensation indemnity claims or related experience in the workers′ compensation industry

• A valid California Class C Driver License or the ability to utilize an alternative method of transportation when needed to carry out job-related essential functions

• Insurance Education Association Certificate and California Workers' Compensation Self-Insured Certificate preferred

• Prior employers′ designation Certificate required in claims handling

The physical demands described are representative of those that must be met by the employee to successfully perform the essential functions of this job. Metro provides reasonable accommodation to enable individuals with disabilities to perform the essential functions.

Working Conditions

• Typical office situation

• Close exposure to computer monitors and video screen

Physical Effort Required

• Sitting at a desk or table

• Operate a telephone or other telecommunications device and communicate through the medium

• Type and use a keyboard and mouse to perform necessary computer-based functions

• Communicating through speech in the English language required