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Sr. Workers Compensation Claims Adjuster

Job Description:

A Senior Workers' Compensation Claims Examiner, under the supervision of the Director of Workers Compensation, ensures access to any and all benefits necessary to cure or relieve the effects of an occupational injury or illness. The Senior Workers' Compensation Claims Examiner administers these benefits as required by the California Labor Code. Effectively works with the injured Member and provider to facilitate the Member's recovery while mitigating risk. This is a highly dynamic and collaborative role that requires outstanding customer service and communication skills.

Requirements:

Duties/Responsibilities:

• Ensure timely and accurate liability decisions and benefit provisions.
• Initiate "Three-Point Contact" with Member County, injured employee and medical provider.
• Initiate, coordinate and ensure early return-to-work efforts with worker and member.
• Proactively manage, finalize, and control an inventory of cases.
• Authorize medical treatment within pre-established authority level.
• Review, investigate, analyze, and adjust workers' compensation claims in accordance with current laws and regulations.
• Establish claims reserves and authorize payments within reserving authority limits.
• Review progress of claims with members, providing a well-documented action plan and acting as a resource for claims questions and guidance.
• Authorize appropriate payments of medical bills, temporary and permanent disability, and death benefits within pre-established limits.
• Review and process bills for payment in accordance with the established fee schedule and contractual agreements.
• Attend conferences and hearings necessary to properly administer resolution of claims.
• Coordinate resolution of claims by preparing legal documents, including Stipulations, and Compromise and Release settlements within authority limits.
• Coordinate with defense counsel on litigated claims, providing records and reports, as necessary.
• Consult with and monitors service providers, such as legal counsel, medical and vocational professionals.
• Refer appropriate claims for potential subrogation recovery.
• Attend conferences and hearings necessary to properly administer resolution of claims.
• Regularly handles private and proprietary information while maintaining strict confidentiality and protecting from unauthorized disclosure.
• Stay apprised of current law changes, court rulings and related matters that might affect the handling of claims.
• Performs various routine clerical duties, utilizing standard office equipment to include: maintaining calendars; entering information into databases and spreadsheets; making photocopies; faxing documents; typing; and word processing.
• Will require overnight travel to attend training, meetings, and claims reviews.
• Keep Workers' Compensation Director apprised of any and all claims requiring special attention, or that have extenuating circumstances.
• This senior-level position may include supervisory responsibilities, including overseeing the work of other claims adjusters, mentoring junior staff, and supporting departmental goals through leadership and collaboration.
• Perform other duties as assigned by Workers' Compensation Director.
• Performs all work in a safe and effective manner.

Required Skills/Abilities:

• Knowledge of claims administration, case management and cost containment solutions as applicable to Workers' Compensation rules in California including 4850.
• Excellent organizational skills and attention to detail.
• Strong analytical and problem-solving skills.
• Excellent oral and written communication skills.
• Demonstrated ethical conduct.
• Effective analytical, problem solving and interpretive skills.
• Proficient with Microsoft Office Suite and/or related software.

Education and Experience:

• Minimum of 5 years' experience in administering occupational claims in California.
• California Self-Insurance Plans Administrator Certification (SIP).
• Five (5) years of Workers' Compensation claims experience required.
• Four-year degree in Occupational Health and Safety or related field desired.
• Other combinations of education and experience may be considered.

Application Procedures:

Please apply at www.trindel.org or email resume to rhartman@trindel.org