Workers' Compensation Analyst (Risk Management)

Metro’s mission is to provide a world-class transportation system that enhances the quality of life for all who live, work, and play within LA County.

Description

Performs journey-level workers' compensation functions in accordance with the California Labor Code and assists employees with work-related injuries return to work and assume their customary duties or to Transitional Duty.The Workers' Compensation Analyst position is fast-paced and detail-oriented. Responsibilities include reviewing incoming medical bills, reports, legal correspondence, and processing Requests for Authorization in a timely manner. The role also involves managing incoming calls and emails, ensuring timely issuance of benefit payments, and generating appropriate benefit letters. Additionally, the position requires preparation and organization for file reviews.

Recruitment Timelines: Interviews are projected to be scheduled for the week of August 25th, 2025. These dates are subject to change. We encourage you to monitor your governmentjobs.com profile and emails for the latest updates.

Examples of Duties

Conducts journey-level investigations upon receipt of new claims

Reviews and responds to all incoming legal and medical mail on a timely manner in accordance with California Labor Code regulations

Audits claim files to ensure all benefits have been paid appropriately

Provides timely and quality customer service to all Metro staff as well as outside providers

Maintains close working contact with injured employees and division personnel

Maintains claim files on an effective diary system

Meets with division personnel on a quarterly basis to review open Workers' Compensation cases

Works closely with legal to strategize on appropriate handling of claims

Contributes to ensuring that the Equal Employment Opportunity (EEO) policies and programs of Metro are carried out

May be required to perform other related job duties

Minimum Qualifications

A combination of education and/or experience that provides the required knowledge, skills, and abilities to perform the essential functions of the position. Additional experience, as outlined below, may be substituted for required education on a year-for-year basis. A typical combination includes:

Education

Bachelor's Degree in Business Administration, Human Resources, or a related field

Experience

One year of relevant experience examining California Workers' Compensation indemnity claims or related experience in the workers' compensation industryCertifications/Licenses/Special Requirements

A valid California Class C Driver License or the ability to utilize an alternative method of transportation when needed to carry out job-related essential functions

Insurance Education Association Certificate and California Workers' Compensation Self-Insured Certificate preferred

Prior employers' designation Certificate required in claims handling

Preferred Qualifications

Preferred Qualifications (PQs) are used to identify relevant knowledge, skills, and abilities (KSAs) as determined by business necessity. These criteria are considered preferred qualifications and are not intended to serve as minimum requirements for the position. PQs will help support selection decisions throughout the recruitment. In addition, applicants who possess these PQs will not automatically be selected.

The following are the preferred qualifications:

Experience applying workers' compensation labor code laws when providing benefits or denying a claim

Experience reading medical reports to explain timelines for the provision of benefits

Experience conducting full-cycle workers' compensation claims

Experience monitoring and/or processing provisions of workers compensation benefits, time limitations, and benefit letters

Experience reviewing medical reports and Whole Person Impairment calculations and rating Maximum Medical Improvement reports

Essential Knowledge

Knowledge of (defined as a learned body of information that is required for and applied in the performance of job tasks)

Theories, principles, and practices of workers' compensation claims administration

California State Labor Code and other applicable laws, rules, and regulations governing workers' compensation

American Medical Association Guidelines

Permanent Disability Ratings

Applicable business software applications

Skill in (defined as the proficient manual, verbal, or mental utilization of data, people, or things)

Performing professional workers' compensation claims administration work

Calculating wages

Analyzing situations, identifying problems and issues, and recommending solutions

Exercising sound judgment when faced with complex issues

Communicating effectively verbally and in writing

Interacting professionally with various levels of Metro employees and outside representatives

Conducting and reporting outcomes of roundtable sessions to discuss cases

Ability to (defined as a present competence to perform an observable behavior or produce an observable result)

Read and interpret legal reports

Review and rate medical reports

Work with legal representatives to resolve matters or cases

Work aggressively to bring cases to resolution without legal actions

Handle work assignments and meet time constraints on a strict diary system to ensure deadlines are met

Organize and prioritize work

Compile, analyze, and prepare comprehensive management reports

Use good judgment when handling highly confidential information

Understand, interpret, and apply laws, rules, regulations, policies, procedures, contracts, budgets, and labor/management agreements

Travel to offsite locations

Read, write, speak, and understand English

Special Conditions

The physical demands described are representative of those that must be met by the employee to successfully perform the essential functions of this job. Metro provides reasonable accommodation to enable individuals with disabilities to perform the essential functions.

Working Conditions

Typical office situation

Close exposure to computer monitors and video screen

Physical Effort Required

Sitting at a desk or table

Operate a telephone or other telecommunications device and communicate through the medium

Type and use a keyboard and mouse to perform necessary computer-based functions

Communicating through speech in the English language requiredNW

Metro is an Equal Opportunity Employer and does not discriminate on the basis of race, color, creed, ancestry, national origin, gender, marital status, sexual orientation, religion, age, veteran status, or disability. Learn more about Metro’s Equal Employment Opportunity Program. Metro does not deny participation in the application process to anyone with prior justice system involvement, in line with Fair Chance hiring practices.

Selection Procedure

Applicants who best meet job-related qualifications will be invited to participate in the examination process that may consist of any combination of written, performance, or oral appraisal to further evaluate job-related experience, knowledge, skills and abilities.

Application Procedure

To apply, visit Metro's website at and complete an online Employment Application.

Computers are available to complete online Employment Applications at the following Metro locations:

METRO Headquarters, Employment Office

One Gateway Plaza

Los Angeles, CA 90012

Open: Monday through Friday, 8am-4pm

(Closed Sat & Sun)

Metro Talent Hub

8501 S. Evermont Place

Los Angeles, CA 90044

Open: Monday through Friday, 9am-5pm

(Closed Sat & Sun)

East Los Angeles Customer Center

4501 B Whittier Blvd

Los Angeles, CA 90022

Open: Tuesday through Saturday, 10am to 6pm

(Closed Sun & Mon)

Wilshire/Vermont Customer Center

3183 Wilshire Blvd, Ste 174

Los Angeles, CA 90010

Open: Monday through Friday, 10am-6pm

(Closed Sat & Sun)

Rosa Parks Customer Center

Willowbrook/Rosa Parks Station

11720 Wilmington Ave

Los Angeles, CA 90059

Open: Monday through Friday, 6am to 6:30pm

(Closed Sat & Sun)

Telephone: or persons with hearing or speech impairments can use California Relay Service 711 to contact Metro.

All completed online Employment Applications must be received by 5:00 p.m. on the closing date. Late applications will not be considered.

*Open to the public and all Metro employees

This job bulletin is not to be construed as an exhaustive list of duties, responsibilities, or requirements. Employees may be required to perform other related job duties.