Career Opportunity

Claims Manager - Worker's Compensation Division - Department of Human Resources (0923)

Recruitment: RTF0132589-01151762

Published: April 12, 2023

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

About:

4/12/2023 - This job posting has been amended to extend the application deadline to 4/23/2023.

This is a Position-Based Test conducted in accordance with CSC Rule 111A.

Specific information regarding this recruitment process are listed below:

• Application Opening: Friday, March 31, 2023
• Application Deadline: Sunday, April 23, 2023 (extended from 4/16/23)
• Compensation for Range A: $131,248 - $167,492 Annually
• Eligible List duration resulting from this examination process will be six (6) months.
• Certification Rule for the eligible list resulting from this examination will be rule of the list
• Exam Type: Combined, Promotive and Entrance
• Recruitment ID: RTF0132589-01151762

The Workers Compensation Division (WCD) of the Department of Human Resources (DHR) is entrusted to manage the City’s Self-Insured, mostly Self-Administered Workers Compensation Program that provides medical treatment and wage-replacement benefit support to injured City employees.

Role description

Reporting to the Assistant Director of Claims, the Claims Manager will oversee major claims operations for the Worker's Compensation Division to ensure adequate and appropriate oversight of our Self-Administered, Self Insured program. 

MAJOR, IMPORTANT AND ESSENTIAL DUTIES

• Provides quality assurance, performance monitoring and oversight of day-to-day handling of claims in the City & County’s Self-Insured workers’ compensation claims teams to ensure prompt, efficient, and cost-effective handling of claims in accordance with applicable city, county, state and federal laws. This includes overseeing and supervising front line and supervisory staff; and/or our Third Party Administrator 
• Supports, implements quality and performance of the CCSF Medical Provider Network to enhance capacity, assess and monitor provider performance outcomes, and adherence to CCSF policies
• Oversees the performance of the CCSF contracted Utilization Review/Bill Review vendor services
• Manages claim operations, reporting, and tracking for the Alternate Dispute Resolution (ADR) “Carve-Out” program between the City and the San Francisco Police Officer Association (SFPOA) and Firefighters’ Local 798
• Implements policies, procedures and initiatives for business process improvements as directed by the Assistant Director - Claims
• Develops appropriate claim reserving and manages cases with high reserves as determined by the Deputy Director or Assistant Director - Claims
• Responsible for training and development of subordinate staff
• Implements statutory and regulatory changes that affect the CCSF business processes
• Oversees quality and performance monitoring of a third-party administrator as directed
• Ensures that best practice standards are continually identified and implemented   
• Evaluates and authorizes claim denials, high-value payments, and high-value settlements as requested by the Assistant Director - Claims
• Works with the City Attorney’s Office to coordinate litigation strategies as appropriate
• Develops, analyzes, and reports performance metrics for the claims operation in  the TPA, should the position oversee the TPA
• Develops, analyzes, and reports performance metrics pertaining to the ADR program and for the CCSF WCD Claims Operations 
• Works cooperatively with the Supervisor Team, line staff and the Management Team to produce required reports to various regulatory agencies 
• Supports technological improvements and systems and works with staff in terms of implementing them. This includes, but is not limited to: the Claims Enterprise claims management information system, electronic filing of court documents through EAMS, and electronic bill payment systems
• Supports return-to-work to improve outcomes for CCSF employees and departments. This includes Temporary Transition Work policy and ODG Predictive Modeling
• Leads and supports anti-fraud activities, including authorizing investigations as appropriate and preparing cases for the District Attorney/Department of Insurance Fraud Unit
• In partnership with Medical Policy staff, implements and supports medical management initiatives
• Leads and manages the Catastrophic Illness Program
• Performs dedicated customer service for client departments; to include managing and troubleshooting service issues; data and information sharing on claims experience; and oversight of Claims Reviews and reporting as requested and as feasible
• May include additional duties as assigned

How to qualify

Minimum Qualifications:

1. Baccalaureate degree from an accredited college or university AND

2. Five years of professional level experience in a Worker's Compensation Program delivering worker's compensation or risk management services.

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 is equivalent to one year.
• 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:

• At least 2 years of supervisory experience in a Worker's Compensation Program delivering worker's compensation or risk management services.
• 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

The stated desirable qualifications may be considered at the end of the selection process when candidates are referred for hiring.

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. 

All work experience, education, training and other information substantiating how you meet the minimum qualifications must be included on your application by the filing deadline. Information submitted after the filing deadline will not be considered in determining whether you meet the minimum qualifications. 

Resumes will not be accepted in lieu of a completed City and County of San Francisco application.

Applications completed improperly may be cause for ineligibility, disqualification or may lead to lower scores.

What else should I know?

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 a 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. Supervisory Test Battery (STB) (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 Supervisory Test (and a suggested reading list) please visit: Supervisory 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 Supervisory 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. The eligible list/score report resulting from this civil service examination process is subject to change after adoption (e.g., as a result of appeals), as directed by the Human Resources Director or the Civil Service Commission. The duration of the eligible list resulting from this examination process will be of 6 months, and may be extended with the approval of the Human Resources Director.  

To find Departments which use this classification, please see 
https://sfdhr.org/sites/default/files/documents/Forms-Documents/Position-Counts-by-Job-Codes-and-Department-FY-2021-22.pdf

Terms of Announcement and Appeal Rights:

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 by the posting the correction on the Department of Human Resources website at 
https://careers.smartrecruiters.com/CityAndCountyOfSanFrancisco1/ 

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.

Exam Analyst Information: If you have any questions regarding this recruitment or application process, please contact the analyst, Ana Britt at ana.britt@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.