Claims Examiner

City of Compton•Compton, CA

6d•Onsite

About The Position

Under general supervision, examines and adjusts claims for Workers' Compensation benefits; monitors claim expenditures; communicates with physicians, supervisors, employees and attorneys regarding illness or injury related to employment; and performs other related duties. The primary duties and responsibilities include reviewing, examining and adjusting Workers' Compensation claims, receiving and recording all claims and determining compensability. The role involves authorizing medical treatment and/or change of physician utilizing California State Workers' Compensation Law, and computing and authorizing payments according to California Labor Code, including medical bills, temporary and permanent disability payments. The Claims Examiner advises employees and dependents of entitlement to Workers' Compensation benefits under state law and City policies, arranges special investigations and medical examinations including return to work exams, and advises departments regarding procedures and reporting deadlines involving work related injuries. The position also involves contacting injured employees to explain benefits and legal rights under the Labor Code, preparing subrogation and litigation cases and corresponding with doctors and attorneys on litigated cases. The Claims Examiner serves as custodian of records, produces records and attests to validity under the direction of the court by subpoena, compiles pertinent facts, makes thorough analyses, and arrives at sound decisions, while maintaining and enforcing all aspects of security and confidentiality of records and information. This role may exercise supervision over subordinate personnel, including the Claims Technician.

Requirements

Possession of a Bachelor’s degree from an accredited college or university in Business Administration or a related field, AND two (2) years of experience adjusting workers’ compensation claims with a public agency or third-party administrator; OR an equivalent combination of education and experience.
Must possess a valid California Class C Driver’s License.
Knowledge of City organization, operations, policies and procedures.
Knowledge of City Code, City Ordinances, and Standard Operating Manual.
Knowledge of State of California Labor Code and Workers' Compensation law.
Knowledge of Medical terminology, anatomy, and technical terminology used in the medical profession related to the cause and treatment of occupational injuries and diseases.
Knowledge of Investigative techniques, methods and procedures.
Knowledge of Vocational rehabilitation processes and programs.
Knowledge of MS Office computer applications.
Skill in compiling pertinent facts, making thorough analyses or Workers' Compensation claims and arriving at sound decisions.
Skill in understanding, interpreting and applying State Labor Code, Workers' Compensation Law, and City regulations.
Skill in establishing and maintaining cooperative working relationships with co-workers.
Skill in operating a personal computer utilizing a variety of business software.
Skill in effective communication, both verbal and written.

Nice To Haves

Two (2) years of supervisory experience is highly desirable.

Responsibilities

Reviews, examines and adjusts Workers' Compensation claims.
Receives and records all claims and determines compensability.
Authorizes medical treatment and/or change of physician utilizing California State Workers' Compensation Law.
Computes and authorizes payments according to California Labor Code, including medical bills, temporary and permanent disability payments.
Advises employees and dependents of entitlement to Workers' Compensation benefits under state law and City policies.
Arranges special investigations and medical examinations including return to work exams.
Advises departments regarding procedures and reporting deadlines involving work related injuries.
Contacts injured employee to explain benefits and legal rights under the Labor Code.
Prepares subrogation and litigation cases and corresponds with doctors and attorneys on litigated cases.
Serves as custodian of records; produces record and attests to validity under the direction of the court by subpoena.
Compiles pertinent facts, makes thorough analyses, and arrives at sound decisions.
Maintains and enforces all aspects of security and confidentiality of records and information.
Performs other duties as assigned or required.