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! We have an immediate opening for Worker's Compensation Insurance Supervisor II (WCIS II) / Claims Operations Specialist in our Utilization Review Team. We are seeking an independent self-starter that is both analytical and creative and can drive for quality results on high-impact projects that align with the Division of Workers' Compensation regulations.

The Claims Operations Specialist is responsible for management of Utilization Review and development of strategic programs. You will conduct analytical studies and surveys, formulate procedures and policies, make recommendations to address adverse trends, lead project teams, and represent the department in industry meetings. You will be expected to exercise independent judgment in evaluating and resolving policy issues and trends.

This position may be filled in any State Fund location, which includes Eureka, Vacaville, Glendale, Pasadena, Redding, Pleasanton, Stockton, Fresno, Bakersfield, San Diego or Sacramento.


Ideal candidate should have:
• 3+ years of claims experience in California Workers Compensation
• Have recent experience acting as a lead or participated as a team member on claims related projects

The successful candidate should possess the following Skills & Abilities:
• Effective written and verbal communication skills
• Experience acting as a lead or mentor in your area of work
• Proven track record of effectively collaborating cross-functionally
• Experience working with and relating to customers with varying needs, to effectively resolve complex issues
• Demonstrated ability to consistently meet or exceed goals and commitments
• Project management or coordination experience
• Excellent problem-solving skills to achieve best outcomes
• Experience researching, analyzing, and interpreting laws/regulations, policies, and procedures to proactively make and implement recommendations and decisions
• Experience performing Claims related audits
• Willing to travel, which may include overnight 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

You will find additional information about the job in the Duty Statement .

Working Conditions


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.

• WORKERS' COMPENSATION INSURANCE SUPERVISOR II

Additional Documents

• Job Application Package Checklist
• Duty Statement

Position Details Job Code #:
JC-533022


Position #(s):
View phone number on click.appcast.io-XXX

Working Title:
Claims Operations Specialist


Classification:
WORKERS' COMPENSATION INSURANCE SUPERVISOR II $7,033.00 - $8,740.00
New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable.


# 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:


Special Requirements
Effective July 1, 2025, the State of California implemented the Personal Leave Program 2025 (PLP 2025) which reduces an employee's monthly salary in exchange for leave credits. Employees appointed to this classification will have their monthly salary reduced and will accrue hours of PLP 2025 on the first day of each pay period in accordance with the applicable bargaining contract. The salary range(s) included on this job posting do not reflect the reduction in pay.

To be considered, you must provide a fully completed STD 678 application and resume. If a Statement of Qualifications (SOQ) is required for this posting, it must also be submitted as instructed in the "Required Application Package" section. Alternative documents submitted in lieu of required Application, Resume, or Statement of Qualifications will not be accepted. Completed STD 678 must include duties performed, start and end dates, and hours worked per week for each position held.


If this posting requires an SOQ, Artificial intelligence (AI) tools such as ChatGPT, website searches, and third-party reviewers can be helpful in researching responses to the SOQ; however, by submitting your application for this position, you understand and acknowledge the SOQ you submit is your own work, in your own words, and accurately reflects your knowledge, skills, abilities, and experiences. Submitting a document that is not your own may be cause for disqualification from the hiring process


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: 10/9/2026
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 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
Mailing Address
Attn: JC-533022 VL
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
Talent Acquisition/Staffing
JC-533022 VL
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 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 limit your response to 2 pages.
  • What motivates you about the Claims Operations Specialist position and what success would look like to you in relation to the duty statement?
  • Describe a time you analyzed complex data sets to identify a problem and outline the solution you implemented based on your findings.
  
  
  

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 Benefit information can be found on the CalHR website and the CalPERS website.

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






Contact Information
The Human Resources Contact is available to answer questions regarding the position or application process.
Department Website:
Human Resources Contact:
Vanessa La
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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
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California Relay Service: View phone number on click.appcast.io (TTY), View phone number on click.appcast.io (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.