Monterey County WORKERS COMPENSATION MANAGER

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1 Monterey County 14C85 WORKERS COMPENSATION MANAGER DEFINITION Under general direction, develops, manages, evaluates, and administers the County s self-insured Workers Compensation and Modified Work programs. Reviews, approves and negotiates settlement of claims. Assists with the selection and monitoring of third party claims administrators. Ensures compliance with State and Federal regulations. Assists departments to coordinate the return to work of injured employees. Provides claims, benefit and retirement information and assistance to injured employees, agency/department supervisors, liaisons and managers; and provides direction to other departments and workers compensation representatives. DISTINGUISHING CHARACTERISTICS This position reports to the Principal Risk and Benefits Analyst in the County Administrative Office and is primarily responsible for initiatives supporting the County Workers Compensation program. The Workers Compensation Manager works with a high degree of independence in the application of program responsibilities such as loss control, medical management and vocational rehabilitation, requiring a thorough knowledge of laws, procedures, and regulations affecting Workers Compensation. This position is also responsible for assisting departments in the determination of appropriate Modified Duty and early Return-to-Work programs. The activities of this classification impact or interrelate with the activities and services of all County departments. The Workers Compensation Manager classification is distinguished from the next higher class of Principal Risk and Benefits Analyst in that the latter is a single-position management classification that has responsibility for the management, direction, implementation and supervision of the County s Public Liabilities, Loss Prevention, Safety, Risk Management and Employee Benefits programs, policies and procedure development, and to provide supervision to subordinate staff. The Workers Compensation Manager classification is distinguished from the Safety Officer classification in that the latter has primary responsibility for a comprehensive and effective County safety program and administers the County Drug Testing Program. This classification is distinguished from the Ergonomics Manager in that the latter is primarily responsible for initiatives supporting the County s Ergonomic injuries prevention program. EXAMPLES OF DUTIES 1. Develops, implements, and monitors County Workers Compensation Programs, i.e., loss control, medical management and vocational rehabilitation. 2. Establishes short and long term department goals. Sets objectives and strategies to reduce countywide injuries and achieve cost containment. 3. Analyzes claim loss and cost reserve data and monitors claims processing. 4. Schedules Return to Work/Fitness for Duty medical consultations for non-industrial and industrial disabilities, and provides appropriate information to employee, doctors and impacted departments. 5. Coordinates the determination of compensability of injuries and payment of temporary and permanent disability, and medical, legal, investigative and other costs relative to Workers Compensation laws and the County s Workers Compensation Program.

2 6. Prepares and presents status reports, settlement proposals, coverage options, trial results, and serious injury reviews on a regular basis. 7. Communicates with departments and legal counsel regarding serious or suspect injuries, repetitive claims activity, fraud claims and litigation. Monitors litigated cases and provides written guidelines to attorney. 8. Appears before the Workers Compensation Appeals Board for hearings and mandatory settlement conferences. 9. In collaboration with the Ergonomics Manager and the Safety Officer, develops and provides related training programs to County departments and staff for various related policies, laws, and benefit provisions impacting the County. 10. Supervises the investigation and adjustment of workers compensation claims by professional and paraprofessional staff and/or external professional firms. 11. Authorizes the acceptance, delay or denial of workers compensation benefits. Ensures that benefits and payments are provided on a timely basis. 12. Hires, trains, develops, and supervises staff. Sets goals and priorities for staff. Assesses performance and provides feedback. Counsels or disciplines, as required. 13. Performs related duties as required. QUALIFICATIONS A combination of experience, education, and/or training which substantially demonstrates the following knowledge, skills and abilities: Knowledge and Skills: Thorough knowledge of: 1. State of California Labor Code, Workers Compensation laws and regulations. 2. American with Disabilities Act (ADA) rules and regulations governing self-insurance. 3. Principles, methods, standards, and limitations in organizing and administering a comprehensive Safety and Workers Compensation Program. 4. Methods of evaluating workers compensation claims. 5. Medical and technical terminology and proper treatment protocols for industrial injuries. 6. Workers Compensation Appeals Board rulings and procedures. Working knowledge of: 1. Best practices in developing and implementing return-to-work programs. 2

3 2. Environmental, sociological, physical, and psychological factors encountered in implementing a Worker s Compensation Self-Insurance Program in a multi-cultural work environment. 3. Principles, practices and techniques of negotiation, budgeting, personnel supervision, management analysis and organizational design necessary to formulate, implement, and evaluate administrative policies. Skill and Ability to: 1. Supervise the review, investigation and evaluation of workers compensation claims. 2. Understand, interpret, apply and communicate provisions of Federal, State, and local legislation, rules and regulations pertinent to the administration of Workers Compensation programs and policies; analyze new and revised statutes and proposed legislation in the area of Workers Compensation to determine effects on County programs and departments. 3. Analyze relevant factors of claims including medical reports, investigative reports, legal correspondence, interview and other communication with appropriate personnel and experts. 4. Set priorities and establish claims processing procedures in accordance with County policy. 5. Supervise or lead professional and paraprofessional staff. 6. Evaluate programs utilizing outcome data to determine the effectiveness of components and implement modifications as necessary. 7. Communicate effectively, both orally and in writing and including public speaking, in a multi-cultural environment, with the employees, County management, local, state, and federal agencies, and third party consultants or vendors. 8. Establish and maintain cooperative working relationships with all County employees, department managers, third parties, regulatory agencies and the general public and provide excellent customer service. 9. Act as a consultant and trainer to other County staff. 10. Implement caseload management techniques. 11. Analyze problems and needs of injured employees and develop courses of action that lead toward constructive solutions. 12. Prepare clear and concise reports. REQUIRED CONDITIONS OF EMPLOYMENT As a condition of employment, the incumbent will be required to: 1. Possess a valid California Class C Driver s License, or the employee must be able to provide suitable transportation, which is approved by the appointing authority. EXAMPLES OF EXPERIENCE/EDUCATION/TRAINING 3

4 The knowledge, skills and abilities listed above may be acquired through various types of experience, education or training, typically: License: Certification as a California Self-Insured Administrator, which is issued by the California State Department of Labor, is desirable. Experience: OPTION I Five 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; Experience: OR OPTION II Three years of experience performing duties equivalent to the classification of Senior Risk and Benefits Analyst with Monterey County investigating, adjusting, and resolving Workers Compensation claims; Education: AND College course work equivalent to a Bachelor s Degree from an accredited college or university with a major study in Business or Public Administration, Political Science, Human Resources, Risk Management, or a closely related field. PHYSICAL AND SENSORY REQUIREMENTS The physical and sensory abilities required for this classification include: 1. Personal mobility to attend meetings and work in various office locations. 2. Ability to work at a desk and/or computer, or be seated while attending meetings for extended periods of time. 3. Finger and manual dexterity in order to operate a computer keyboard. 4. Ability to stoop, reach and bend to access files, lift and carry items up to 30 pounds. 5. Vision sufficient to function in a typical office environment, including close and distance vision, and ability to adjust focus. 6. Ability to communicate verbally in a clear manner and with a volume required to respond to telephone and face-to-face inquiries/communication. 7. Hearing must be sufficient to distinguish and identify sounds and voices in a typical office environment. 8. Agility and mobility to drive a motor vehicle. 4

5 CLASS HISTORY CLASS DATA Class Code: 14C85 Job Group: 03 Established Date: July, 2007 EEO Category: P Revised Date: (New) Work Comp. Code: 8810 Former Title: (New) Bargaining/Employee Unit: X FLSA: E MOCO OT: N Prepared by: Daylene Ivey, SPHR Management Specialist Approved by: /s/ Ruby Urueta, Associate Personnel Analyst County Administrative Office July 2, 2007 Date 5