Claims Operations Specialist

Are you ready to join a high performing team who influences the delivery of superior treatment outcomes for injured employees? Are you passionate about helping others and doing the right thing? Do you desire to create a more positive customer experience?

If the answer is YES and you believe you have what it takes, we would like to talk to you about joining the Claims Medical and Regulatory Division CMRD team! There are 3 openings, 1 in Medical Provider Network (MPN) unit, 1 in Ancillary Network unit, and 1 in Utilization Review unit.

• The MPN Specialist is a resource and technical subject matter expert managing sensitive and complex projects while overseeing the operations for State Fund's MPN and medical management programs.
• The Utilization Review Specialist is responsible for m anagement of Utilization Review, Chronic Pain Program and development of strategic programs.
• The Ancillary Network Specialist is responsible for managing the ancillary network and development of programs/processes to enhance operational effectiveness.

These positions may be fille in the following locations: Rohnert Park, Eureka, Vacaville, Riverside, Glendale, Los Angeles, San Luis Obispo, Redding, Pleasanton, Stockton, Fresno, Bakersfield, Santa Ana, San Diego or Sacramento.

We are seeking an independent self-starter that is both analytical and creative and has the ability to drive for quality results on high-impact projects that align with the Division of Workers' Compensation regulations.

The successful candidate should possess the following Skills & Abilities:

• Demonstrated ability to work independently and within a team to accomplish assigned objectives and deliverables on time with quality
• Clear and concise written and excellent verbal communication skills
• Strong proven analytical skills and problem solving skills
• Ability to lead, mentor, earn respect and inspire confidence
• Ability to collaborate with others across the organization
• Discretion in working with and relating with other people to achieve judicious conflict resolution for a variety of sensitive issues and complete problems under challenging circumstances
• Can be counted on to exceed goals successfully and is consistently a top performer
• Excellent project management skills
• Outstanding problem solving that innovates to find the best solution
• Researches and analyzes information and interpretation of laws/regulations, policies, and procedures to proactively make and implement recommendations and decisions
• Ability to travel, which may include overnight and extended travel

Every day will be a new and challenging venture. Along the way, you will:

• Independently manage high profile projects from cradle to grave to improve medical management and cost containment
• Conduct audits to ensure compliance with the regulations
• Establish and maintain provider relations for the State Fund through an ongoing exchange of information and education among the medical community
• Evaluate and resolving complex and sensitive State Fund's medical management programs issues
• Manage vendor contracts to ensure compliance with service-level agreements and deliverables
• Collaborate with Corporate Legal & Chief Medical Officer in creating and implementing medical management initiatives
• Independently initiate studies to identify network trends and develop recommendations

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.

The successful candidate must reside in California upon appointment.

Selected candidate(s) hired may be required to attend in-person Onboarding at our Vacaville office with expenses for attendance paid by State Fund.

Minimum Requirements You will find the Minimum Requirements in the Class Specification.

• STAFF SERVICES MANAGER I

Additional Documents

• Job Application Package Checklist
• Duty Statement

Position Details Job Code #:
JC-451249

Position #(s):
402-411-4800-XXX

Working Title:
Claims Operations Specialist

Classification:
STAFF SERVICES MANAGER I $6,963.00 - $8,650.00

# of Positions:
Multiple

Work Location:
United States

Telework:
Telework

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

Resumes submitted in lieu of the STD 678 may not be accepted. Completed STD 678 must include duties performed, start and end dates, and hours worked per week for each position held.

The successful candidate must reside in California upon appointment.

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: 10/21/2024
Who May Apply
Individuals who are currently in the classification, eligible for lateral transfer, eligible for reinstatement, have list or LEAP 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
Talent Acquisition/Staffing
Attn: JC-451249 TS
2275 Gateway Oaks Drive

Sacramento , CA 95833

Address for Drop-Off Application Packages

You may drop off your application and any applicable or required documents at:

State Compensation Insurance Fund
Talent Acquisition/Staffing
Attn: JC-451249 TS
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 - Please answer the SOQ questions below in no more than two pages:
  
  • How will your skills and background help you be successful in an SSM1 role as described in the duty statement?
  • What about the SSM1 position that are you most excited about?
  

Applicants requiring reasonable accommodations for the hiring interview process must request the necessary accommodations if scheduled for a hiring interview. The request should be made at the time of contact to schedule the interview. Questions regarding reasonable accommodations may be directed to the EEO contact listed on this job posting.

Benefits
State Fund employees are eligible for a number of benefits. Our benefit package includes:

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/StaticIndex?id=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:
Tina Sherel
(916) 924-4703
TSherel@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.