Workers' Compensation Claims Adjuster III

Description

Under limited supervision, to analyze, review, investigate and adjust claims submitted by County employees for Workers' Compensation Benefits and to review the work of, evaluate, guide and train lower level Claims Adjusters.

COVID-19 Risk Tier - LowerRisk

Typical Tasks

• Trains, reviews and evaluates the work of lower levels of Workers' Compensation Claims Adjusters;

• Serves as subject matter expert on the more complex Workers' Compensation Claims;

• Adjusts on-the-job injury claims for County employees and determines compensability and reserve requirements;

• Conducts interviews with claimants, witnesses, supervisors and physicians regarding claims to ascertain the creditability of the claims;

• Identifies need for modified or alternate work accommodations or retraining services;

• Requests and records substantiating documentation from physicians, departments and witnesses;

• May prepare the litigation file, develop the case and negotiate Compromise and Release agreements or stipulations and/or assists counsel in these functions;

• May represent the County before the Workers' Compensation Appeals Board;

• Makes provisions for medical treatment, payment of medical bills and all compensation benefits;

• Manages and controls caseload through periodic review of all open cases and determines course of action including case closures;

• Initiates investigation of accidents or injury causes and the status of disabled employees in order to determine facts and evidence to support the satisfactory disposition of cases;

• Prepares reports and correspondence;

• Performs related work as required.

Employment Standards

Sufficient education, training and work experience to demonstrate the possession of the following knowledges and abilities:

1.Possession of a Bachelor's Degree or a total of four (4) years of specialized workers' compensation programs and courses and/or experience comparable to a Claims Technician with Santa Clara County.

2.And one (1) of the following:

A. Possession of a State of California Self-Insurance Certificate.

OR

B. Completion of at least 160 hours of workers' compensation training, of which at least 120 hours shall be conducted in a classroom with an instructor, completed within a 12 month period.

OR

C. Have worked five (5) years in the last eight (8) years of on-the-job experience adjusting California workers' compensation claims, or supervising claims adjusters handling workers' compensation claims.

3.Possession of a valid California driver's license prior to appointment and the ability to qualify for and maintain a County Driver's Permit.

Ongoing Special Requirement:

Workers' Compensation Claims Adjusters III are required to complete Post Designation Training of thirty (30) hours every two (2) years.

Knowledge of:

• Workers' compensation principles and policies;

• Provisions of the Workers' Compensation Laws of California;

• Practices and procedures of the Workers' Compensation Appeals Board;

• Medical and legal terminology;

• Current trends in decisions of the courts and Workers' Compensation Appeals Board on compensation cases;

• The effective use of the Schedule for Rating Permanent Disabilities;

• Resources available for providing modified or alternate work accommodations or retraining of the injured or disabled;

• Common office computer applications such as word processing, spreadsheet and databases;

• Office practices and procedures.

Ability to:

• Exercise good judgment in interpreting and applying the provisions of the Workers' Compensation Laws;

• Collect and analyze legal and medical evidence and draw sound conclusions;

• Establish and maintain cooperative and effective working relationships with those contacted in the course of work;

• Oversee the day-to-day operations of a work unit;

• Speak and write effectively.