WORKERS' COMPENSATION COMPLIANCE ANALYST 2

AS612 $35,069 - $68,806
Creation Date: 06/29/1987
Change Date: 01/01/2025

FUNCTION OF WORK:
To regulate and enforce compliance of statutes governing the Office of Workers' Compensation Administration claim filing process by workers' compensation insurance carriers or self-insured funds.

LEVEL OF WORK:
Experienced

SUPERVISION RECEIVED:
General from Workers' Compensation Compliance Supervisor or higher level administrator.

SUPERVISION EXERCISED:
May serve as lead worker over Workers' Compliance Analysts 1 and/or lower level employees.

JOB DISTINCTIONS:
Differs from Workers' Compensation Compliance Analyst 1 by presence of experienced level duties.

CORE COMPETENCIES:
IDENTIFIED BY STATE CIVIL SERVICE, CORE COMPETENCIES ARE THE KNOWLEDGE, SKILLS, ABILITIES AND BEHAVIORS BASED ON THE WORK TASKS OUTLINED IN THE EXAMPLES OF WORK. MORE INFORMATION ON THE SCS COMPETENCY MODEL CAN BE FOUND HERE.

Acting with Ethics and Integrity	Displaying Expertise	Making Accurate Judgments
Managing Resources	Thinking Critically	Training Others
Using Data

EXAMPLES OF WORK:
EXAMPLES BELOW ARE A BRIEF SAMPLE OF COMMON DUTIES ASSOCIATED WITH THIS JOB TITLE. NOT ALL POSSIBLE TASKS ARE INCLUDED.

Monitors the workers' compensation claim filing process for compliance with regulations, OWCA procedures and applicable laws; provides and maintains confidential document-related services; reviews computer reports to discover delinquent claims, and initiates and monitors collection activities.

Collects, compiles, edits, and sorts statewide workers' compensation claim forms daily in hard copy and electronic form reported by insurers and self-insurers.

Analyze workers' compensation claim forms to make determinations of proper North American Industry Classification System code (NAICS).

Reviews workers' compensation claims to be coded; searches for precedents and background materials in reference books. Assigns industry codes to workers' compensation claims.

Assesses documented discrepancies in insurance company-submitted claims; reviews calculation of workers' compensation benefit payments and performs verification function; makes adjustments to correct workers' compensation benefit payments.

Confers and corresponds with individuals who submit documents that are not in compliance with statutes and
advises specific adjustments needed for approval.

Collects fines/fees from insurers who failed to file claim forms in the established time frame. Creates periodic and special reports and maintains logs to track status of information and projects.

Provide consultation to the information system teams to develop system requirements and enhancements.

Provide technical assistance and training to employers, insurance carriers, attorneys, and employees concerning basic and complex claim forms.

QUALIFICATION REQUIREMENTS:
MINIMUM QUALIFICATIONS:
Four years of experience in worker's compensation claims or dispute resolution, injury investigation, insurance claims examining, or statistical analysis; OR

Six years of full-time experience in any field plus one year of experience in worker's compensation claims or dispute resolution, injury investigation, insurance claims examining, or statistical analysis; OR

A bachelor's degree plus one year of experience in worker's compensation claims or dispute resolution, injury investigation, insurance claims examining, or statistical analysis.

EXPERIENCE SUBSTITUTION:
Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.