Workers Compensation Claims Adjuster

Workers Compensation Claims Adjuster

Job Description: 

• Receive and review Workers’ Compensation claims and reports and determine if occupational illness or injury is compensable; authorize and compute payment utilizing California State Workers’ Compensation Law; advise employee and dependents of entitlement to Workers’ Compensation benefits under state law and County policy.
• Develop documentation for claim reports by requesting substantiating reports from physicians, supervisors and witnesses; review injury reports for completeness and consistency; resolve discrepancies in data; advise departments regarding procedures and reporting deadlines involving work injuries.
• Explain to injured workers their benefits and legal rights under Workers’ Compensation Laws.
• Prepare subrogation and litigation cases and correspond with physicians and attorneys on litigated cases; attend Worker’ Compensation Appeals Board Hearings and authorize settlements under $50,000 as delegated by the Risk Manager; may serve as a witness at appeal hearings; arrange special investigations and medical examinations.
• Prepare briefs of Personnel and Health Department information to Workers’ Compensation attorneys for submittal to the Workers’ Compensation Appeals Board; secure documentary evidence of births, deaths, marriages and divorces in fatality cases. Serve as custodian of records;
• produce records and attest to validity under the direction of the Court by subpoena; represent the County in Small Claims Court.
• Prepare and present informational seminars or in-service training to explain the County Workers’ Compensation Program.
• May assign and review the work of others; train new employees.
• Provides vacation and temporary relief as required.
• Employee should have three (3) years of experience adjusting workers’ compensation claims, including one (1) year adjusting complex litigated claims.

Knowledge of:

• Relevant Federal, State and local laws and regulations governing workers’ compensation.
• American Medical Association (AMA) guidelines as they apply to workers’ compensation.
• Medical and technical terminology used in industrial injury cases.
• Methods and techniques of data collection, research, and analysis.
• Principles and procedures of report preparation.
• Basic principles and practices of analytical, statistical and financial report preparation.
• Principles of business letter writing.
• Principles and practices of record keeping and records management.
• Principles and procedures of financial record keeping and reporting.
• Modern office procedures and methods including computer equipment and supporting applications.
• English usage, spelling, grammar, and punctuation.

Schedule:

• Monday – Friday 8:00am – 5:00pm
• In-office work, with possibility of remote work

Pay rate: 

• $32.55/hr