Career Opportunity

Assistant Director of Worker's Compensation Claims (0932) - Department of Human Resources

Recruitment: RTF0128274-01116155

Published: November 17, 2022

Apply using SmartRecruiters, the City and County of San Francisco's application portal.

About:

11/17/22 - This announcement has been amended to include qualifying substitution language and to extend the announcement through November 23, 2022.

Role description

Reporting to the Worker's Compensation Division Director, the Assistant Director of Worker's Compensation Claims, provides oversight of overall Claims Operations, in the City & County’s Self-Insured workers’ compensation division to ensure the prompt, efficient, and cost-effective handling of claims in accordance with applicable city, county, state and federal laws. This includes, but is not limited to: day-to-day handling of claims teams through a Claims Manager; Oversight of the City’s Medical Provider Network (MPN), and oversight of direction of work performed by the Third-Party Claims Administrator (TPA).

In addition, the Assistant Director of Claims reviews and directs work and high-value payments within authority. In those instances where settlements exceed the authority of subordinate supervisory and managerial staff, the Assistant Director of Claims would review and make recommendations for settlements and work with City Attorneys to determine strategies for resolution.

MAJOR, IMPORTANT AND ESSENTIAL DUTIES

• Perform oversight of all Claims Operations, which include day-to-day claims handling through subordinate Claims Manager, oversight of our Medical Provider Network, and Claims Compliance with federal, state and local statutes in terms of workers compensation claim handling and benefit administration.
• Oversee and manage the City’s Medical Provider Network (MPN) through subordinate Supervisor and through contracted service providers. This includes, but not limited to: coordination of the MPN Committee, development and implementation of MPN provider vetting processes and troubleshooting, and maintenance of our MPN documentation, Access Assistance, and tracking as required by the State of California.  
• Through subordinate Claims Manager, perform effective oversight of the City’s Alternate Dispute Resolution (ADR) program with the San Francisco Police Officer Association and San Francisco Firefighters Local 798. This includes service on the governing Joint Labor Management Committee, maintaining required tracking of ADR data and reporting as required by the State of California, effective collaboration and communication with the Ombudsperson and ADR Director, maintenance of Independent Medical Evaluator (IME) lists and oversight, and ensure staff training and adherence to terms of the program.
• Maintain, develop and implement required reporting and data to the State of California as required by Statute. This includes but is not limited to: Annual staff Training and Certification logs and reports to the State, MPN document reapprovals and modifications, Annual Office of Self-Insured Plans (OSIP) reporting and Alternative Dispute Resolution Program due to the state.
• Directs, through subordinate manager(s) and supervisors, the work of employees engaged in handling worker’s compensation cases. Ensures appropriate staffing and training of staff for the claims management function.
• Develops and implements best practice standards and measurement tools to monitor efficiency and effectiveness for worker’s compensation claims management of City workers and sets standards for Third-Party-Administrators (TPA) claims management and monitors performance against these standards.
• Directs strategic planning activities with emphasis on a seamless operation with the TPA, safety and prevention, cost containment, rigorous analysis of Worker’s Compensation data, and effective reporting to departments.
• Develops appropriate claim reserving and settlement evaluation guidelines in coordination with the Deputy Director; monitors claims handling on cases with payments and claim exposure exceeding $250,000. Evaluates high-cost settlements, appeals and any precedent setting litigation; coordinates with upper management and City Attorney’s Office regarding these claims and develops practices and standards for litigation support.  Authorizes high-cost settlements up to authority maximum for in-house and TPA offices.
• Ensures appropriate coordination, through internal and external medical resources, with nurse case managers, regarding disability management techniques and implementation of medical protocols.
• Evaluates the impact of pending legislation of CCSF claims operations and worker’s compensation expenditures; keeps abreast of Worker’s Compensation statutes and case law to maintain compliance with the Labor Code.
• Assesses and implements technological applications to streamline processes and achieve maximum operating efficiency.  Utilizes automated risk and claims management information systems for analytical and reporting purposes.
• Utilizes automated risk and claims management information systems for analytical and reporting purposes.
• Create, develop, implement and manage staffing plans, including caseload analyses, staffing ratios, and span of work and control. This includes providing recommendation and plans for enhancement.
• Develop and implement an internal training program for line staff in an effort for a pathway forward to promote internally within the division.

How to qualify

Minimum Qualifications:

1. Bachelor's degree from an accredited college or university AND

2. Five years of professional level experience in a Workers Compensation Program delivering workers’ compensation or risk management services. This experience must include three (3) years experience supervising professionals handling workers’ compensation claims which includes determining compensability, authorizing benefits, investigating, and resolving claims.

Substitution:

• Additional experience as a California workers' compensation claims adjuster and/or a claims assistant may substitute for the required degree on a year-for-year-basis. One year of verifiable experience equals thirty (30) semester or forty-five (45) quarter units.
• Completion of college level coursework may substitute for the required degree on a year-for-year basis. Thirty (30 semester or forty-five (45) quarter units.
• A California Workers' Compensation Claims Administration (WCCA) certificate, California Workers Compensation Claims Professional (WCCP) certificate or equivalent from Insurance Educational Association (IEA) or comparable entity may substitute for one (1) year of the required experience or one (1) year of the required education.

Desirable Qualifications:

• Prior experience in a managerial role in a Workers Compensation Claims Administration Program Handling Claims for a Self-Insured employer.
• Possession of a Self-Insured Plans (SIP) Certificate with the State of California’s Office of Self-Insured Plans
• Prior experience and knowledge of various types of claims administrator programs and the differences between each of them; to include (but not limited) Insured Claims; Self-Insured/Self-Administered, Third Party Administrators, Joint Power Authority, Schools, and/or Alternate Dispute Resolution Programs

Verification of Education and Experience:

Applicants may be required to submit verification of qualifying education and experience at any point during the recruitment and selection process. If education verification is required, information on how to verify education requirements, including verifying foreign education credits or degree equivalency, can be found at https://sfdhr.org/how-verify-education-requirements

Note: Falsifying one’s education, training, or work experience or attempted deception on the application may result in disqualification for this and future job opportunities with the City and County of San Francisco.

What else should I know?

Specific information regarding this examination process are listed below.

• Application Opening – Wednesday, November 2, 2022
• Application Deadline – Wednesday, November 23, 2022
• Compensation for Range A: $151,918 - 193,856 Annually
• Eligible List duration resulting from this examination process will be six (6) months.
• Certification Rule for this examination will be Rule of the List.
• Exam Type: Combined, Promotive and Entrance
• Appointment Type: Permanent Civil Service
• Recruitment ID: RTF0128274-01116155

Selection Procedures

After application submission, candidates deemed qualified must complete all subsequent steps to advance in this selection process, which includes the following:

1. Minimum Qualification Supplemental Questionnaire (MQSQ) - Candidates will be required to complete MQSQ as part of the employment application. This MQSQ is designed to obtain specific information regarding an applicant's experience in relation to the Minimum Qualifications (MQ) for this position. The MQSQ will be used to evaluate if the applicant possesses the required minimum qualifications.

2. Management Test Battery (MTB) (weighted 40%) -  Candidates who meet the minimum qualifications will be invited to participate in a computer-based examination designed to measure competencies in job-related areas which may include but are not limited to: Problem Solving; Leadership; Decision Making; Interpersonal skill; Human Resources Management; Team Building; Communication & Conflict Management. For more information about this Management Test (and a suggested reading list) please visit: Management Test Battery. Please note: this examination is only held in San Francisco. This is a standardized examination and, therefore, test questions and answers are not available for public inspection or review.

3. Supplemental Questionnaire Exam (weighted 60%) - Candidates who meet the qualifications of the position will be required to complete the Supplemental Questionnaire Exam as a part of the selection process. The Supplemental Questionnaire is designed to measure the knowledge, skills and abilities required for the position. Responses to the questionnaire will be reviewed and rated by a panel of subject matter experts and is subject to verification.

A passing score on the Management Test Battery and Supplemental Questionnaire must be achieved in order to be placed/ranked on the Eligible List. Candidates will be placed on the eligible list in rank order according to their final score.

Eligible List/Score Report: A confidential eligible list of applicant names that have passed the civil service examination process will be created, and used for certification purposes only. An examination score report will be established, so applicants can view the ranks, final scores and number of eligible candidates. Applicant information, including names of applicants on the eligible list, shall not be made public unless required by law. However, an eligible list shall be made available for public inspection, upon request, once the eligible list is exhausted or expired and referrals resolved. Candidate scores on this examination may also be applied to other announcements involving other job titles, when directed by the Human Resources Director.

Upon approval of the Human Resource Director (see Civil Service Rule 111A.26.5), the eligible list resulting from this announcement may be used by other departments that also use this classification or a similar classification. To find other Departments which use this classification, please click here.

Terms of Announcement:

This is a Position Based Test conducted in accordance with Civil Service Rule 111A. Applicants must be guided solely by the provisions of this announcement, including requirements, time periods and other particulars, except when superseded by federal, state or local laws, rules or regulations.  Clerical errors may be corrected and, if so, an amended note will be posted on this official job announcement.

The terms of this announcement may be appealed under Civil Service Rule 111A.35.1. The standard for the review of such appeals is ‘abuse of discretion’ or ‘no rational basis’ for establishing the position description, the minimum qualifications and/or the certification rule.  Appeals must include a written statement of the item(s) being contested and the specific reason(s) why the cited item(s) constitute(s) abuse of discretion by the Human Resources Director.  Appeals must be submitted directly to the Executive Officer of the Civil Service Commission within five business days of the announcement issuance date.

Additional Information Regarding Employment with the City and County of San Francisco

• Information About The Hiring Process
• Position Based Testing Information
• Conviction History
• Employee Benefits Overview  
• Equal Employment Opportunity 
• Disaster Service Worker
• ADA Accommodation
• Veterans Preference
• Seniority Credit in Promotional Exams
• Right to Work
• Copies of Application Documents
• Diversity Statement

HOW TO APPLY

Applications for City and County of San Francisco jobs are only accepted through an online process. Visit https://careers.smartrecruiters.com/CityAndCountyOfSanFrancisco1/ and begin the application process.

• Select the “I’m Interested” button and follow instructions on the screen

Applicants may be contacted by email about this recruitment and, therefore, it is their responsibility to ensure that their registered email address is accurate and kept up-to-date. Also, applicants must ensure that email from CCSF is not blocked on their computer by a spam filter. To prevent blocking, applicants should set up their email to accept CCSF mail from the following addresses (@sfgov.org, @sfdpw.org, @sfport.com, @flysfo.com, @sfwater.org, @sfdph.org, @asianart.org, @sfmta.com, @sfpl.org, @dcyf.org, @first5sf.org, @famsf.org, @ccsf.edu, @smartalerts.info, and @smartrecruiters.com).

Applicants will receive a confirmation email that their online application has been received in response to every announcement for which they file. Applicants should retain this confirmation email for their records. Failure to receive this email means that the online application was not submitted or received.

Questions: If you have any questions regarding this recruitment or application process, please contact the analyst, Gary Chen at gary.w.chen@sfgov.org.

Your information will be kept confidential according to EEO guidelines.

CONDITION OF EMPLOYMENT:  All City and County of San Francisco employees are required to be fully vaccinated against COVID-19 as a condition of employment. Someone is fully vaccinated when 14 days have passed since they received the final dose of a two-shot vaccine or a dose of a one-shot vaccine. Any new hire must present proof of full vaccination status to be appointed. Any new hire who will be routinely assigned or occasionally enter High-Risk Settings, must provide proof of having received a COVID-19 booster vaccine by March 1, 2022, or once eligible.

The City and County of San Francisco encourages women, minorities and persons with disabilities to apply. Applicants will be considered regardless of their sex, race, age, religion, color, national origin, ancestry, physical disability, mental disability, medical condition (associated with cancer, a history of cancer, or genetic characteristics), HIV/AIDS status, genetic information, marital status, sexual orientation, gender, gender identity, gender expression, military and veteran status, or other protected category under the law.