SANTA ANA UNIFIED SCHOOL DISTRICT CLAIMS EXAMINER BASIC FUNCTION: Under direction of the Director of Risk Management, receive and administer claims made against the District's self-insurance program, including workers' compensation claims, liability claims and property claims. Direct investigations, pursue subrogation opportunities, calculate and pay benefits, direct attorneys representing the District on litigated claims, pay appropriate amounts to medical providers and vendors, maintain a pro-active settlement program. DISTINGUISHING CHARACTERISTICS: Has highly developed written and oral communication skills in handling casualty and property claims. Possesses an in-depth knowledge of relevant law (including statutory, case, and regulatory law) and extensive medical knowledge. Works competently in the administration of a large number of litigated and complex claims. Proficiency in written and oral Spanish as well as English is highly desirable. REPRESENTATIVE DUTIES: Determine District's legal obligation to claimant. E Investigate questionable claims. E Defend against false and fraudulent claims. E Calculate and authorize payment of work comp benefits. E Select and mail appropriate benefit notices. E Adjust and authorize bills for payment. E Establish and maintain proper work flow. E Prepare reports, memos, and letters. E Identify safety hazards. E Maintain a file diary. E Perform related duties as required. CLAIMS EXAMINER: (Continued) KNOWLEDGE AND ABILITIES: KNOWLEDGE OF: Workers' compensation law and procedures. Liability and property law. Civil litigation procedures. Medical terminology and procedures as they relate to casualty claims. Computer claim software and word processing software. KNOWLEDGE AND ABILITIES (CONTINUED) ABILITY TO: Establish rapport and communicate articulately with others. Work with minimal supervision to solve problems and settle claims. Interpret and apply statutes, regulations, and case law. Understand and rate medical reports. Set realistic case reserves. Meet schedules and time lines. Operate computers, fax machines, and other office equipment. Take accident and injury reports. Perform the essential functions of the job. EDUCATION AND EXPERIENCE: Graduation from high school and two years' experience as a claims examiner adjusting lost time and litigated cases. WORKING CONDITIONS: ENVIRONMENT: Office environment with heavy phone traffic. Constant interruptions. PHYSICAL ABILITIES: Hearing and speaking to accurately exchange information in person or on the telephone. Seeing to read a variety of materials. Sitting for extended periods of time. Dexterity of hands and fingers to operate a computer keyboard. Bending at the waist, kneeling or crouching to file materials. Lifting or moving objects, normally not exceeding twenty (20) pounds. Accommodation may be made to enable a person with a disability to perform the essential functions of the job with or without reasonable accommodation. Board Approved: (8/99 5/01) 5/05