Address
Form of workThe Claims Processing Center - Medical Reimbursement Analysis Unit has an immediate opening for a Medical Reimbursement Adjuster at the Workers' Compensation Claims Adjuster level. This is a unique opportunity for a self-motivated individual with strong analytical and communication skills to support the CPC and Claims staff in determining appropriate fee schedule and reimbursement policies and amounts. This position may be located in any of the following work locations: Fresno, Glendale, Pleasanton, Redding, Riverside, Rohnert Park, Santa Ana, or Vacaville.
The following is a brief outline of the duties of the Medical Reimbursement Adjuster as envisioned by the management team:
• Respond to fee schedule and workflow related questions submitted to the Bill Review Helpdesk
• Provide ongoing support for the bill review software application to ensure the effectiveness and efficiency of State Fund's Automated Bill Review programs including Capstone rules programming, testing, and import
• Participate as SME and/or serve as project lead on Medical Reimbursement related projects and initiatives
• Provide oversight, administration and authorization for exception reimbursement outside applicable fee schedule or business practices
A minimum of 2 years recent Medical Reimbursement policy and/or senior level bill review experience is preferred.
To be considered for this position you must provide a completed application and resume. You may be disqualified from the recruitment process if ALL fields of the application are not COMPLETE. Resumes will not take the place of an application.
New to state candidates will be hired into the minimum salary of the classification or minimum of the alternate salary range when applicable. Placement to alternate salary range may be based on education or experience identified in your state application.
You will find additional information about the job in the Duty Statement .
Working Conditions
Telework may be available and is subject to change based on State Fund guidelines and business needs. This position will require several on-site visits per year whether or not telework option has been granted.
Selected candidate(s) hired may be required to attend in-person Onboarding at our Vacaville office. Expenses for Onboarding attendance would be paid by State Fund.
Minimum Requirements You will find the Minimum Requirements in the Class Specification.
- WORKERS' COMPENSATION CLAIMS ADJUSTER
- Job Application Package Checklist
- Duty Statement
Position Details Job Code #:
JC-423319
Position #(s):
402-666-9325-XXX
Working Title:
Medical Reimbursement Adjuster
Classification:
WORKERS' COMPENSATION CLAIMS ADJUSTER $4,214.00 - $4,786.00 A
$4,346.00 - $5,439.00 B
$5,746.00 - $7,190.00 C
# of Positions:
1
Work Location:
United States
Telework:
Hybrid
Job Type:
Permanent, Full Time
Department Information
State Fund is California's largest provider of workers' compensation insurance. Established in 1914 by the state legislature, we offer diverse and comprehensive products and services that provide a strong and stable option for employers and injured employees with fast, reliable claims service and medical and indemnity benefits.
Our culture centers on our purpose and values. We exist to provide fairly priced workers' compensation insurance, make workplaces safe, and restore injured workers. To fully represent California, we are committed to our employees by embracing and celebrating our diverse workforce and fostering inclusion to make the workplace a dynamic environment for all. We recognize and reward high performance, yet value a healthy work/life balance.
Department Website: http://www.statefundca.com
Special Requirements
Incomplete applications may also result in removal from consideration. You are required to complete employment history on the application form (STD 678). You may be disqualified from the recruitment process if the employment history is not complete.
Resumes will not take the place of employment history. If you are meeting minimum qualifications with education, you must include your unofficial transcripts for verification. If selected, you may be required to provide official transcripts at the time of hire.
Application Instructions
Completed applications and all required documents must be received or postmarked by the Final Filing Date in order to be considered. Dates printed on Mobile Bar Codes, such as the Quick Response (QR) Codes available at the USPS, are not considered Postmark dates for the purpose of determining timely filing of an application.
Final Filing Date: 3/30/2024
Who May Apply
Individuals who are currently in the classification, eligible for lateral transfer, eligible for reinstatement, have list eligibility, are in the process of obtaining list eligibility, or have SROA and/or Surplus eligibility (please attach your letter, if available). SROA and Surplus candidates are given priority; therefore, individuals with other eligibility may be considered in the event no SROA or Surplus candidates apply.
Applications will be screened and only the most qualified applicants will be selected to move forward in the selection process. Applicants must meet the Minimum Qualifications stated in the Classification Specification(s).
How To Apply
Complete Application Packages (including your Examination/Employment Application (STD 678) and applicable or required documents) must be submitted to apply for this Job Posting. Application Packages may be submitted electronically through your CalCareer Account at www.CalCareers.ca.gov. When submitting your application in hard copy, a completed copy of the Application Package listing must be included. If you choose to not apply electronically, a hard copy application package may be submitted through an alternative method listed below:
Address for Mailing Application Packages
You may submit your application and any applicable or required documents to:
State Compensation Insurance Fund
Attn: JC-423319EC
PO BOX 659015
Sacramento , CA 95865
Address for Drop-Off Application Packages
You may drop off your application and any applicable or required documents at:
State Compensation Insurance Fund
JC-423319EC
2275 Gateway Oaks Drive
Sacramento , CA 95833
08:00 AM - 05:00 PM
Required Application Package Documents
The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:
- Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at www.CalCareers.ca.gov. All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
- Resume is required and must be included.
- Statement of Qualifications - The theme for the SOQ is:
Provide an example which demonstrates your experience in providing an analysis of a complex DWC fee schedule update; include the resources utilized and how you navigated the data sets.
The SOQ should be typed in Arial 11-point font and be double-spaced. Please limit the lengt to two (2) pages.
Benefits
Health Benefits Program (CalPERS), Retirement (CalPERS), Employer Health and Consolidated Benefits Contributions, Dental, Vision, 401(k) and 457 Deferred Compensation Plans, Employee Assistance Program, Group Legal Services Insurance, Holidays, Vacation/Sick/Other Paid Leave, Flex Elect Reimbursement Program, Wellness and Recognition, Alternate Work Schedules, Transit Pass Program, Tuition Reimbursement, Dependent Scholarship Program, Leadership Training, Mentoring Program
https://www.statefundca.com//Home/StaticIndexid=https://content.statefundca.com//careers/Index.asp
Benefit information can be found on the CalHR website and the CalPERS website.
Contact Information
The Human Resources Contact is available to answer questions regarding the position or application process.
Department Website: http://www.statefundca.com
Human Resources Contact:
Edina
(800) 499-8668
ECole@scif.com
Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office.
EEO Contact:
Rosa Gil-Robles
(800) 499-8668
California Relay Service: 1-800-735-2929 (TTY), 1-800-735-2922 (Voice) TTY is a Telecommunications Device for the Deaf, and is reachable only from phones equipped with a TTY Device.
Background Investigation
Prior to employment with State Compensation Insurance Fund, a background investigation (BI) will be initiated.
Acknowledgement
Electronic applications submitted through your CalCareer Account are highly recommended and will be received/processed faster than other methods of filing.
By applying to this position, you are also acknowledging that you have received the following information:
- California State benefits
- Duty statement/Job Description
- Salary ranges and steps for the classification(s) advertised
Equal Opportunity Employer
The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.
It is an objective of the State of California to achieve a drug-free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants.
