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The City of Sacramento is seeking an experienced Workers’ Compensation Claims Representative to join its Risk Management team. In this role, you will be responsible for administering benefits, investigating, and resolving workers’ compensation claims in compliance with State of California laws. You will collaborate with various City departments, employees, medical professionals, attorneys, and other stakeholders while managing the full spectrum of claims from initiation to closure. Experience with administering 4850 benefits for first responders is preferred, but not required.
THE POSITION
With supervisor approval, incumbents may be eligible for intermittent remote work;
however, they must physically reside within the Sacramento region or have the ability to
regularly report to a City of Sacramento physical worksite with little notice.
Under general supervision, the Workers' Compensation Claims Representative performs a wide variety of responsible duties in claims adjusting related to the City's self-administered Workers' Compensation Program; provides timely Workers' Compensation benefits pursuant to State of California laws; investigates, evaluates, and settles Workers' Compensation claims against the City of Sacramento; attends mandatory settlement conferences, court hearings, and meetings.
DISTINGUISHING CHARACTERISTICS
This exempt classification is populated with multiple incumbents. The Workers' Compensation Claims Representative performs the entire range of specialized duties requiring a thorough knowledge of all aspects of the Workers' Compensation Program. When filled from the outside, significant prior experience in adjusting Workers' Compensation claims is required.
SUPERVISION RECEIVED AND EXERCISED
General supervision is provided by a Workers' Compensation Claims Supervisor or higher-level management staff.
ESSENTIAL DUTIES AND RESPONSIBILITIES
The following duties are typical for this classification. Incumbents may not perform all the listed duties and/or may be required to perform related duties as needed:
Reviews accident and injury reports and Doctor's First Report of Injury forms to determine proper actions under Workers' Compensation laws and regulations; obtains background information; and opens and adjusts claims; pays temporary disability, permanent disability, and life pension benefits to injured employees; or, pays death benefits to dependents; reviews and pays related medical bills; reviews and pays expenses incurred to defend the City in contested claims; and verifies mileage payment requests, pharmacy reimbursements, and other bills.
Establishes and maintains monetary case reserves to cover medical costs and projected miscellaneous and compensation costs; prepares written requests for settlements; settles litigated cases that do not require a defense attorney and advises as appropriate; reviews cases for subrogation potential and files related actions.
Computes permanent disability case ratings and awards; coordinates benefits with other City benefits; prepares information for submission to the Workers' Compensation Appeals Board, Disability Evaluation Unit, and Administrative Director; files appropriate actions such as answers, declarations, pleadings and objections.
Communicates verbally and in writing with injured employees, their departments, physicians, dependents, attorneys, City safety representatives, Workers' Compensation Appeals Board members, and other interested parties; reviews established claims periodically to prompt action and closure, and/or settlement.
Sets medical evaluations and coordinates return to work, interactive process, utilization review, independent medical review, and independent bill review; attends mandatory settlement conferences, hearings, and meetings relevant to cases.
Provides exceptional customer service to those contacted in the course of work.
Other related duties may also be performed; not all duties listed are necessarily performed by each individual holding this classification.
THIS JOB POSTING WILL AUTOMATICALLY CLOSE UPON THE RECEIPT OF
125 APPLICATIONS OR AT THE FINAL FILING DEADLINE, WHICHEVER OCCURS FIRST.
Knowledge of:
State of California Workers' Compensation laws, administrative regulations, and claims adjusting procedures.
Principles and practices of permanent disability rating, utilization review program, independent medical reviewprogram, independent bill review program, supplemental job displacement benefits program, return to workprogram and disability management programs.
Principles and practices of reserving and excess carrier reporting.
Medical and legal terminology relating to Workers' Compensation matters.
Oral presentation techniques.
Skill in:
Evaluate permanent disability.
Use of computers, computer applications, and software.
Ability to:
Interpret, explain, and apply Workers' Compensation laws and administrative rules and regulations.
Analyze complex data, including medical reports, and make appropriate decisions.
Make accurate arithmetical computations.
Speak and write effectively.
Establish and maintain effective relationships with injured employees and their families, attorneys, and physicians.
EXPERIENCE AND EDUCATION
Experience:
Three years of Workers' Compensation claims adjusting experience in an insurance company, third-party administrator, or self-insured employer. Public agency experience is desirable.
-AND-
Education:
Possession of an Associate's Degree or 60 semester units or equivalent quarter hours from an accredited college or university with major course work in public or business administration, economics, accounting, human resources, or a related field.
Substitution:
Additional qualifying experience may substitute for the required education on a year for year basis.
- OR -
Possession of certificate proving successful completion of the Self-Insurance Administrator's Examination may substitute for the required education.
PROOF OF EDUCATION
Should education be used to qualify for this position, then proof of education such as, but not limited to, university/college transcripts and degrees should be submitted with your application and will be required at the time of appointment. Unofficial documents and/or copies are acceptable.
An applicant with a college degree obtained outside the United States must have education records evaluated by a credentials evaluation service.
Evaluation of education records will be due at time of appointment.
SPECIAL QUALIFICATIONS
Certification:
Possession of an Experienced Claims Examiner designation is required at time of appointment, per California Insurance Code Section 11761.
Possession of, or ability to obtain by time of appointment, required post-designation training, pursuant to is required at time of appointment, per California Insurance Code Section 11761 and California Code of Regulations, Title 10, Sections2592.02, 2592.03, 2592.04, and 2592.05.
PROOF OF CERTIFICATION
Proof of the required certificate and/or license should be submitted with your application and will be required at the time of appointment. Unofficial documents and/or copies are acceptable.
