Workers' Compensation Claims Examiner

Job Summary

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 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.

Supplemental Information

How to Apply:

Applicants must submit a clear, concise, completed on-line City Application along with any required supplemental application materials with the Human Resources Department by the filing deadline. If you do not submit your on-line application by the filing deadline, you will not be considered for this position. Please note, applications may be rejected if incomplete. Resumes, CVs and cover letters are not reviewed as part of the application screening process.

Selection Process:

All applicants must submit clear, concise and complete information regarding your work history and qualifications for the position. All applicants will be reviewed and only those applicants determined to be most qualified on the basis of experience, training and education, as submitted, will be invited to participate further in the selection process.

Testing may consist of a combination of any of the following and is subject to change as needs dictate:

Training and Experience Evaluation
Writing Project

Oral Interview

WORKING CONDITIONS:

Work is typically performed in an office environment. Office work may require sitting for prolonged periods of time and using a computer keyboard, mouse, and screen. The incumbent is required to visit various community facility sites and may be exposed to change weather conditions and temperatures. Offsite assignments and irregular work hours are also required. Attends community and commission meetings and participates on committees which may occur during evening or on weekends.

The City's liberal fringe benefits for full-time employment include sick leave, holiday and vacation pay, the Public Employees Retirement System, medical, dental and vision insurance, credit union, deferred compensation, tuition reimbursement, Dependent Care Assistance Plan and priority enrollment consideration at Hill & Dale Family Learning Center, Marine Park Child Development Center, and Santa Monica Early Childhood Lab School.

Closing Date/Time: 4/3/2025 5:30 PM Pacific

Please mention you found this employment opportunity on the CareersInGovernment.com job board.

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• City of Santa Monica

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