Workers Compensation Analyst

Class Characteristics

Under direction, to provide workers compensation claims analysis, investigation and administration; to consult with employees and County management regarding workers compensation benefits, the claim process, return-to-work, and light duty options; authorize payment for medical treatment; set reserves for future claims costs and negotiate and authorize claims settlements; and to do other work as required.

Distinguishing Characteristics

The Department of Human Resources provides human resources services to all County departments, including recruitment and selection, HR policy administration, employee and labor relations, classification, compensation and pay equity, organizational development, employee engagement and development, employee wellness and benefits administration, risk management, workers' compensation, liability and casualty claims management, and human resources information systems.

The Workers Compensation Analyst performs a variety of journey-level professional and technical work in the administration of the County's workers' compensation claims. In coordination with the County's Risk & Safety Manager, the incumbent is responsible for activities related to the investigation and claims administration of job related injuries.

The Workers Compensation Analyst differs from the Risk & Loss Control Analyst which consults with departments to identify exposures to loss and assist in the development and implementation of safety, loss prevention and risk management programs. It further differs from the Leave and Accommodations Analyst who provides specialized support related to leave programs and ADA administration.

Tyical Tasks

Duties may include but are not limited to the following:

1. Reviews and assists with preparation of annual bu
2. nalyzes all workers' compensation claims documents; investigates and evaluates all claims with new or omitted medical condition submissions for compensability within statutorily required time limits; approves or denies claims; establishes claims reserves and negotiates claims resolutions and settlements within assigned limits; recommends and/or implements settlement offers.
3. Implements claims cost control measures; reviews medical bills, authorizes payments; reviews and authorizes time loss records; identifies and pursues potential cost recovery from third parties; investigates suspected claims fraud; refers claimants to private rehabilitation organizations.
4. Promotes early return to work and light duty options for injured workers; consults with physicians and rehabilitation professionals to identify medical conditions and physical limitations/restrictions; coordinates with departments to determine if work duties can be adjusted to accommodate injured workers on a permanent or temporary basis; monitors light-duty work assignments, maintains required documents and requests reimbursement from Employer at Injury Program.
5. Calculates employee average weekly wage and determines medically authorized disability payments; coordinates time sheet entries and applicable information with Payroll; issues timely Notice of Closures or permanent disability payments as required.
6. Assigns claims to defense counsel as appropriate; coordinates with County Counsel and/or outside legal counsel on litigation of claims; collaborates and prepares litigation strategies with counsel to properly defend the case; attends litigation hearings; identifies and evaluates cases for exposure and potential settlement.
7. Provides consultation to supervisors and employees related to the workers' compensation claim process; counsels supervisors and employees about return to work and light duty options; develops and maintains relationships with the medical community to raise awareness of the County's light duty programs; provides resources such as medical care locations, work release forms and other pertinent information to employees and supervisors in a variety of forums for easy access.
8. Compiles and completes required workers compensation forms and reports; completes and distributes appropriate forms and correspondence.
9. Participates in Risk Management strategic planning efforts and budgeting process relative to County Risk and Safety programs, services, projects or issues under consideration; ass
10. dgeting process for workers compensation by monitoring claims activity and costs; prepares reports for the Risk Manager regarding projections for reserves.

Required Knowledge and Skills

Thorough knowledge of: State workers compensation statutes and administrative rules; methods and procedures of workers' compensation claims investigation and administration.

Working knowledge of: Interviewing techniques; medical terminology; techniques of medical case monitoring; techniques of gathering and analyzing medical and claims information; methods and techniques of statistical research, analysis and reporting; County government organization and operations; County collective bargaining agreements; injured worker rehabilitation statutes and rules; court procedures and legal processes used in claims litigation; record keeping on a cloud-based risk and claims management system.

Skill to: Evaluate workers compensation insurance claims; interpret and apply federal, state laws and rules; train and educate County employees in workers compensation matters; conduct thorough investigation, evaluate alternatives and reach sound, fact-based conclusions and recommendations; prepare clear and concise reports; prepare and maintain accurate records; project claims reserves and monitor claims costs; represent the County professionally and negotiate settlements of claims on its behalf; communicate effectively, both orally and in writing; establish and maintain cooperative working relationships with individuals and groups who come from diverse background including claimants, County employees, medical providers, attorneys and other outside vendors and consultants.

Minimum Qualifications

Minimum qualifications are used as a guide for establishing the minimum experience, education, licensure, and/or certifications required for employment in the classification. The following minimum qualifications are established for this classification. Additional minimum qualifications and special conditions may apply to a specific position within this classification and will be stated on the job announcement.

Experience: A minimum of five (5) years of related experience that would provide the required knowledge and skills to perform the responsibilities of this position.

Licenses/Certifications: 
The following licensure/certifications are required at the time of hire.

• Certification as a Claims Examiner from the State of Oregon.

Pre-Employment Requirements

Driving may be necessary for County business. For position(s) with occasional/incidental driving, incumbents must possess a valid driver's license. Accommodation requests for an acceptable alternative method of transportation will be reviewed on an individual basis in compliance with State and Federal legislation.

Classification No. 398
Established: 10/81
Revised: 12/87, 1/93, 12/25
Archived: 12/97
Reactivated and Revised: 7/20 
FLSA: Exempt
EEO: 2