Workers' Compensation Claims Representative I

City of San Diego • San Diego, CA

1d

About The Position

Workers' Compensation Claims Representative I investigates, reviews, evaluates, and administers workers' compensation claims. The position reviews medical reports, sets reserves, files documentation, reviews and approves medical bills for payment, and reviews accident and injury reports. It interviews and corresponds with claimants, witnesses, attorneys, and physicians; approves claims or recommends denial; and represents the City in workers' compensation and industrial leave claims actions and hearings. Other duties may be assigned.

This is not an entry-level position. Applicants must have a valid California claims adjuster designation and qualifying professional-level workers' compensation claims experience. The position is with the City of San Diego. Successful candidates may be placed on an eligibility list used to fill vacancies for six months.

Requirements

• One year of full-time professional-level experience investigating, adjusting, and settling workers' compensation claims covered by California law.
• Possess a valid designation as a Claims Adjuster, Experienced Claims Adjuster, or Medical-Only Claims Adjuster in accordance with the California Code of Regulations.
• Submit proof of the required claims adjuster designation with the application.
• City of San Diego employees relying on Out-of-Class Assignment experience must submit documentation signed by their appointing authority or payroll specialist, detailing duties, dates, and total qualifying hours.
• Experience with a third-party administrator, insurance company, or self-insured public or private agency qualifies; experience in a law office preparing, negotiating, or settling workers' compensation claims does not qualify.

Nice To Haves

• Possession of a Self Insurance Administrator Certificate issued by the State of California Department of Industrial Relations.

Responsibilities

• Investigate, review, evaluate, and administer workers' compensation claims.
• Review medical reports and set reserves.
• File claim documentation.
• Review and approve medical bills for payment.
• Review accident and injury reports.
• Interview and correspond with claimants, witnesses, attorneys, and physicians.
• Approve claims or recommend denial.
• Represent the City at workers' compensation and industrial leave claims actions and hearings.
• Perform other duties as assigned.

Benefits

• Eligible benefitted employees originally hired on or after July 10, 2021, will be automatically enrolled in the San Diego City Employees Retirement System (SDCERS).
• Employees in classifications represented by the Municipal Employees Association are scheduled to receive general wage increases: 3.5% effective July 1, 2027; 2% effective July 1, 2028; and 2% effective January 1, 2029.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed