Job Description

Job Description and Duties

This is a 24-month limited term position which may be extended, cancelled, or made permanent at any time.

If becoming permanent, the selected candidate must be eligible for a permanent appointment at the time of the LT appointment or at the time of the conversion.

The Claims Processing Center - Medical Reimbursement Analysis Unit has an immediate opening for a Senior Medical Reimbursement Specialist at the Senior Workers' Compensation Claims Adjuster level. This is a unique opportunity for a self-motivated individual with strong analytical and communication skills to create and monitor processes and protocols designed to ensure reimbursement of medical billings that is consistent with applicable fee schedules. This position may be located at any of the following CPC work locations: Fresno, Glendale, Pleasanton, Redding, Riverside, Rohnert Park, Santa Ana, or Vacaville.

Preferably, the successful candidate will have experience with State Fund projects, CPC workflows, vendor technology (e.g. SmartAdvisor), and be able to handle multiple tasks simultaneously, and have an understanding of Claims Processing Center operations. The position will primarily allow the selected candidate to work from home but there will be occasional travel to meet with project team members.

The following is a brief outline of the duties of the Senior Medical Reimbursement Specialist as envisioned by the management team:

• Coordinate development, implementation, and monitoring of strategies and work processes/protocols to manage and resolve State Fund medical bill reimbursement issues
• Provide testing, troubleshooting and overall maintenance of the bill review software application
• Engage in ongoing analysis of reimbursement rules to assure the proper and necessary amount of internal controls are in place to optimize bill handling and payment practices
• Create Capstone rules to reduce the risk of improper payment to medical providers by writing requirements, programming, creating appropriate reason codes, rule testing, and placing the rule(s) into production
• Serve as Subject Matter Experts to lead projects emerging from the CPC's collaboration with other partners such as the Claims Medical and Regulatory Division (CMRD), Corporate Claims, and Complex Legal Unit (CLU)

A minimum of 3 years recent Medical Reimbursement policy and/or senior level bill review experience is preferred. Only the most qualified candidates will be considered and interviewed.

You will find additional information about the job in the .

Minimum Requirements

You will find the Minimum Requirements in the Class Specification.

Additional Documents

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, resume, and statement of qualifications. 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.

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 an SOQ 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: 4/16/2026

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-513284 CA

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-513284 CA

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 -

  A Statement of Qualifications must be provided which addresses the following:

  1. Describe an example of a time you had to propose a capstone rule for SmartAdvisor to address a workflow or fee schedule update.
  2. Explain how you have built and executed a SmartReport to identify if State Fund was properly paying bills.
  3. Describe your experience leading various projects. Include in your description examples of the following attributes:
  • Communication skills
  • Ability to influence final decision-making
  • Understanding how project results impact other programs and contribute to State Fund's overall success

  The SOQ should be typed in Arial 10-point font and be double-spaced. Please limit the length of your writing sample to a maximum of two pages.

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

Contact Information

The Human Resources Contact is available to answer questions regarding the position or application process.

Human Resources Contact:
Carl Agulo
(916) 567-4878
CAgulo@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.

Job Tags

Permanent employment, Full time, Contract work, Work at office, Immediate start, Work from home, Flexible hours

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