Workers Compensation Claims Representative

Job Title: Workers Compensation Claims Representative

Location: San Bernardino, CA

Day Shift: 8AM - 5PM

DESCRIPTION:

Workers' Compensation Claims Adjuster duties shall include, but are not limited to:

• Receive and review Workers' Compensation claims and reports and determine if occupational illness or injury is compensable; authorize and compute payment utilizing California State Workers' Compensation Law; advise employees and dependents of entitlement to Workers' Compensation benefits under state law and County policy.
• Develop documentation for claim reports by requesting substantiating reports from physicians, supervisors and witnesses; review injury reports for completeness and consistency; resolve discrepancies in data; advise departments regarding procedures and reporting deadlines involving work injuries.
• Explain to injured workers their benefits and legal rights under Workers' Compensation Laws.
• Prepare subrogation and litigation cases and correspond with physicians and attorneys on litigated cases; attend Worker' Compensation Appeals Board Hearings and authorize settlements under $50,000 as delegated by the Risk Manager; may serve as a witness at appeal hearings; arrange special investigations and medical examinations.
• Prepare briefs of Personnel and Health Department information to Workers' Compensation attorneys for submission to the Workers' Compensation Appeals Board; secure documentary evidence of births, deaths, marriages and divorces in fatality cases. Serve as custodian of records;produce records and attest to validity under the direction of the Court by subpoena; represent the County in Small Claims Court.
• Prepare and present informational seminars or in-service training to explain the County Workers' Compensation Program.
• May assign and review the work of others; train new employees.
• Provides vacation and temporary relief as required.
• Employee should have three (3) years of experience adjusting workers' compensation claims, including one (1) year adjusting complex litigated claims.

QUALIFICATIONS

Knowledge of:

• Relevant Federal, State and local laws and regulations governing workers' compensation.
• American Medical Association (AMA) guidelines as they apply to workers' compensation.
• Medical and technical terminology used in industrial injury cases.
• Methods and techniques of data collection, research, and analysis.
• Principles and procedures of report preparation.
• Basic principles and practices of analytical, statistical and financial report preparation.
• Principles of business letter writing.
• Principles and practices of record keeping and records management.
• Principles and procedures of financial record keeping and reporting.
• Modern office procedures and methods including computer equipment and supporting applications.
• English usage, spelling, grammar, and punctuation.

Ability to:

• Conduct research and analyze information.
• Negotiate issues and settlements.
• Identify issues and process claims in a timely fashion within the timeframes prescribed by law.
• Gather, organize, compile and summarize data.
• Create and maintain a variety of ledgers, logs, records, and reports.
• Prepare a variety of clear and concise reports, documents, and memoranda.
• Promptly respond to requests and inquiries.
• Prepare and maintain accurate financial records and documents.
• Operate office equipment including computers and supporting word processing and spreadsheet applications.
• Adapt to changing technologies and learn functionality of new equipment and systems.
• Interpret and apply pertinent federal, state and local codes, laws, regulations, and AMA guidelines.
• Understand and carry out oral and written instructions.
• Communicate clearly and concisely, both orally and in writing.
• Establish and maintain effective working relationships with those contacted in the course of work.

Education and Experience Guidelines:

Any combination of education and experience that would likely provide the required knowledge and abilities is qualifying.

Skills : DATA COLLECTION