Join Parma Today
The City of Santa Monica is a progressive, inclusive and culturally-rich community. As leaders in public service, we strive to be an employer of choice by attracting and retaining a highly-talented workforce where people of diverse races, religions, cultures, and lifestyles thrive. Our goal is to create a welcoming and inclusive environment where our staff are empowered to perform at their highest level and where their differences make a positive impact.
The City of Santa Monica invites you to join our team of skilled and dedicated employees. The following job opportunities are open to everyone. Click on the title of any job opportunity for additional details about the position and to Apply.
Performs varied and difficult professional and technical duties in adjusting, analyzing, investigating and resolving the City’s workers’ compensation claims.
Representative Duties:
Reviews, examines and adjusts workers’ compensation claims filed by City employees for injuries and illnesses.
Establishes claims reserve levels and verifies documentation and accuracy. Monitors reserves for appropriate changes as necessary.
Authorizes appropriate payments of workers’ compensation benefits within pre-established authorization limits. Reviews and processes bills for payment in accordance with established fee schedules and contractual agreements with providers of service.
Assists in the investigation of claims for compensability and subrogation issues.
Contacts employees to explain benefits and legal rights under the California Labor Code and applicable City policies and Memorandums of Understanding provisions.
Authorizes hospitalization, surgery and other types of medical treatment as required.
Coordinates and monitors providers of service such as legal counsel and medical and vocational rehabilitation professionals.
Reviews and processes a variety of claim file documents, identifies issues, and ensures adherence to California Labor Code and regulatory requirements.
Coordinates the resolution of claims by preparing legal documents, attending conferences and hearings, and negotiating settlements within specific limits of authority.
Computes all types of indemnity payments, including calculation of temporary and permanent disability rates.
Manages claim progress. Assists in the development of strategies on assigned cases.
Files excess insurance notices and claims.
Monitors City employee salary continuation benefits in conjunction with disability status.
Assigns claims duties to the Workers’ Compensation Claims Assistant.
Performs other related duties as assigned.
Requirements:
Knowledge, Abilities and Skills
Knowledge of:
California workers’ compensation laws and the procedures and regulations of the Administrative Director, Division of Workers’ Compensation
Relevant workers’ compensation case law
Investigation and settlement techniques and practices
Medical terminology, vocational rehabilitation requirements and procedures of claims management and control
Claim reserving within statutory guidelines
Excess insurance reporting requirements
Advanced permanent disability rating
Ability to:
Learn and understand the City’s policies and practices related to workers’ compensation and disability retirements, including applicable Memoranda of Understanding provisions
Organize and manage accurate files and records
Understand, interpret and apply State Labor Code and workers’ compensation case law
Clearly explain rules, procedures, policies and claims decisions to a variety of individuals, including employees, supervisors and management staff
Learn specialized computer software applications
Communicate effectively orally and in writing
Work under the pressure of competing deadlines
Work independently with frequent interruptions
Provide effective customer service
Work with persons from diverse social, cultural, and economic backgrounds as well as a variety of work styles, personalities, and approaches
Skill in:
Using a personal computer and applicable software applications.
REQUIREMENTS
Minimum Qualifications:
Education: Graduation from high school or the equivalent. A bachelor’s degree is desirable.
Experience: Three years of recent, paid, responsible experience as a journey-level workers’ compensation claims examiner.
Public sector and/or self-insured employer workers’ compensation claims adjusting experience is desirable.
Licenses and Certificates:
Must obtain a State of California Self-Insurance Plans Administrator Certificate within six months of employment.
Possession of a valid Class C driver license or the ability to utilize an alternative method of transportation when needed to carry out job-related essential functions.
Submit your application: https://www.governmentjobs.com/careers/santamonica
