Workers Compensation Claims Adjuster

San Bernardino, CA

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$ 32.55 - $ 32.55 Admin Clerical
8/28/2023 3:46:00 PMPST
Job Type: Enterprise Public Sector
Minimum Experience: Not Specified
Recruiter Name: Patricia Lopez

Job Description

DESCRIPTION:
Workers’ Compensation Claims Adjuster duties shall include, but are not limited to:
1. 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.
2. 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.
3. Explain to injured workers their benefits and legal rights under Workers’ Compensation Laws.
4. 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.
5. 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.
6. Prepare and present informational seminars or in-service training to explain the County Workers’ Compensation Program.
7. May assign and review the work of others; train new employees.
8. Provides vacation and temporary relief as required.
9. Employee should have three (3) years of experience adjusting workers’ compensation claims, including one (1) year adjusting complex litigated claims.
Schedule:
Monday – Friday 8:00am – 5:00pm
In-office work, with possibility of remote work

Job Requirements

REQUIREMENTS

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.

Ability to:
  • Conduct research and analyze information.
  • Negotiate issues and settlements.
  • Identify issues and process claims in a timely fashion within the timeframes prescribed by law.
  • Gather, organize, compile and summarize data.
  • Create and maintain a variety of ledgers, logs, records, and reports.
  • Prepare a variety of clear and concise reports, documents, and memoranda.
  • Promptly respond to requests and inquiries.
  • Prepare and maintain accurate financial records and documents.
  • Operate office equipment including computers and supporting word processing and spreadsheet applications.
  • Adapt to changing technologies and learn functionality of new equipment and systems.
  • Interpret and apply pertinent federal, state and local codes, laws, regulations, and AMA guidelines.
  • Understand and carry out oral and written instructions.
  • Communicate clearly and concisely, both orally and in writing.
  • Establish and maintain effective working relationships with those contacted in the course of work.

Education and Experience Guidelines:
Any combination of education and experience that would likely provide the required knowledge and abilities is qualifying. 


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