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 (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. 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. Attends administrative hearings at the WCAB, CalHR meetings, Return To Work 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. Serves as back-up to other unit staff, as needed, by reviewing requests, providing status, and providing general information to claimants, in order to maintain business operations and ensure customer needs are met.