County of Santa Clara is seeking two (2) Workers' Compensation Claims Adjuster III to join our team.
The County Workers' Compensation Program is self-insured and self-administers the claims and provision of benefits to industrially injured employees of the County. Description Under limited supervision, to analyze, review, investigate and adjust claims submitted by County employees for Workers' Compensation Benefits and to review the work of, evaluate, guide and train lower level Claims Adjusters.
Typical Tasks:
Trains, reviews and evaluates the work of lower levels of Workers' Compensation Claims Adjusters
Serves as subject matter expert on the more complex Workers' Compensation Claims
Adjusts on-the-job injury claims for County employees and determines compensability and reserve requirements
Conducts interviews with claimants, witnesses, supervisors and physicians regarding claims to ascertain the creditability of the claims
Identifies need for modified or alternate work accommodations or retraining services
Requests and records substantiating documentation from physicians, departments and witnesses
May prepare the litigation file, develop the case and negotiate Compromise and Release agreements or stipulations and/or assists counsel in these functions
May represent the County before the Workers' Compensation Appeals Board
Makes provisions for medical treatment, payment of medical bills and all compensation benefits
Manages and controls caseload through periodic review of all open cases and determines course of action including case closures
Initiates investigation of accidents or injury causes and the status of disabled employees in order to determine facts and evidence to support the satisfactory disposition of cases
Prepares reports and correspondence
Performs related work as required
Requirements:
Sufficient education, training and work experience to demonstrate the possession of the following knowledges and abilities:
Possession of a Bachelor's Degree or a total of four (4) years of specialized workers' compensation programs and courses and/or experience comparable to a Claims Technician with Santa Clara County.
And one (1) of the following: A. Possession of a State of California Self-Insurance Certificate. OR B. Completion of at least 160 hours of workers' compensation training, of which at least 120 hours shall be conducted in a classroom with an instructor, completed within a 12 month period. OR C. Have worked five (5) years in the last eight (8) years of on-the-job experience adjusting California workers' compensation claims, or supervising claims adjusters handling workers' compensation claims.
Possession of a valid California driver's license prior to appointment and the ability to qualify for and maintain a County Driver's Permit.
Ongoing Special Requirement:
Workers' Compensation Claims Adjusters III are required to complete Post Designation Training of thirty (30) hours every two (2) years
Knowledge of: Workers' compensation principles and policies; Provisions of the Workers' Compensation Laws of California; Practices and procedures of the Workers' Compensation Appeals Board; Medical and legal terminology
Current trends in decisions of the courts and Workers' Compensation Appeals Board on compensation cases
The effective use of the Schedule for Rating Permanent Disabilities
Resources available for providing modified or alternate work accommodations or retraining of the injured or disabled
Common office computer applications such as word processing, spreadsheet and databases
Office practices and procedures
Ability to:
Exercise good judgment in interpreting and applying the provisions of the Workers' Compensation Laws
Collect and analyze legal and medical evidence and draw sound conclusions
Establish and maintain cooperative and effective working relationships with those contacted in the course of work