Claims Examiner

City of Compton; Compton (CA); On-site; USD 65,000 - 90,000; Full time

Job summary

City of Compton seeks a Workers' Compensation Claims Specialist to oversee the examination and adjustment of claims, authorize medical treatments, and compute payments per California Labor Code. The role involves advising employees on benefits, coordinating investigations, and preserving confidentiality of records.

The position reports to the Risk Manager and may supervise staff. A BA in Business Administration and 2 years’ claims experience with a public agency or TPA are required, with

Qualifications

• Bachelor’s degree in Business Administration or related field and two years of experience adjusting workers’ compensation claims with a public agency or third-party administrator.
• Two years of supervisory experience is highly desirable.

Responsibilities

• Reviews, examines and adjusts Workers' Compensation claims.
• Receives and records all claims and determines compensability.
• Authorizes medical treatment and/or change of physician under California State Workers' Compensation Law.
• Computes and authorizes payments according to California Labor Code.
• Advises employees and dependents of entitlement to Workers' Compensation benefits under state law and City policies.
• Arranges special investigations and medical examinations including return to work exams.
• Advises departments regarding procedures and reporting deadlines involving work-related injuries.
• Contacts injured employee to explain benefits and legal rights under the Labor Code.
• Prepares subrogation and litigation cases and corresponds with doctors and attorneys on litigated cases.
• Serves as custodian of records; maintains and attests to validity under the direction of the court by subpoena.
• Maintains and enforces all aspects of security and confidentiality of records and information.

Skills

Claims adjustment

Supervisory experience

Communication

Investigation

Education

Bachelor's degree in Business Administration

Tools

MS Office

Job description

Under general supervision, examines and adjusts claims for Workers' Compensation benefits; monitors claim expenditures; communicates with physicians, supervisors, employees and attorneys regarding illness or injury related to employment; and performs other related duties.

Works under the general supervision of the Risk Manager and/or Worker’s Compensation Claims Administrator. May exercise supervision over subordinate personnel, including the Claims Technician.

The following essential functions are those that are critical, integral, necessary, crucial, primary and fundamental to the job. Incumbents who possess the requisite skill, experience, education, and other job-related requirements of a position are expected to perform the essential functions of the job with or without a reasonable accommodation.

The following duties ARE NOT intended to serve as a comprehensive list of all duties performed by all employees in this classification, only a representative summary of the primary duties and responsibilities. Incumbent(s) may not be required to perform all duties listed and may be required to perform additional, position-specific duties.

• Reviews, examines and adjusts Workers' Compensation claims.
• Receives and records all claims and determines compensability.
• Authorizes medical treatment and/or change of physician utilizing California State Workers' Compensation Law.
• Computes and authorizes payments according to California Labor Code, including medical bills, temporary and permanent disability payments.
• Advises employees and dependents of entitlement to Workers' Compensation benefits under state law and City policies.
• Arranges special investigations and medical examinations including return to work exams.
• Advises departments regarding procedures and reporting deadlines involving work related injuries.
• Contacts injured employee to explain benefits and legal rights under the Labor Code.
• Prepares subrogation and litigation cases and corresponds with doctors and attorneys on litigated cases.
• Serves as custodian of records; produces record and attests to validity under the direction of the court by subpoena.
• Compiles pertinent facts, makes thorough analyses, and arrives at sound decisions.
• Maintains and enforces all aspects of security and confidentiality of records and information.
• Performs other duties as assigned or required.

Education and Experience:

Possession of a Bachelor’s degree from an accredited college or university in Business Administration or a related field, AND two (2) years of experience adjusting workers’ compensation claims with a public agency or third-party administrator; OR an equivalent combination of education and experience. Two (2) years of supervisory experience is highly desirable.

Required Licenses or Certifications:

• Must Possess a valid California Class C Driver's License

Required Knowledge of:

• City organization, operations, policies and procedures. City Code, City Ordinances, and Standard Operating Manual.
• State of California Labor Code and Workers' Compensation law.
• Medical terminology, anatomy, and technical terminology used in the medical profession related to the cause and treatment of occupational injuries and diseases.
• Investigative techniques, methods and procedures.
• Vocational rehabilitation processes and programs.
• MS Office computer applications.

Required Skill in:

• Compiling pertinent facts, making thorough analyses or Workers' Compensation claims and arriving at sound decisions.
• Understanding, interpreting and applying State Labor Code, Workers' Compensation Law, and City regulations.
• Establishing and maintaining cooperative working relationships with co-workers.
• Operating a personal computer utilizing a variety of business software.
• Effective communication, both verbal and written.

Physical Demands / Work Environment:

• Work is performed indoors in an office setting.
• Work requires frequent light lifting, sorting, filing, typing and driving.
• Moderate finger dexterity and near vision is required.
• May be exposed to minor amounts of dust.

EXAMINATION

The purpose of this examination is to establish an eligible list from which vacant position(s) may be filled.

Phase one (1) is a written examination (weighted 50%) which will measure all or portions of the above knowledge, and skills. Phase two (2) is an oral examination (weighted 50%) that will be administered by an appraisal panel to evaluate professional qualifications, background and suitability. A passing score for each phase is 70%. Each candidate will be notified via e-mail of their status at each step of the recruitment.

The City of Compton reserves the right to utilize alternative testing methods, if deemed necessary. Failure in one phase of the examination shall be grounds for declaring the applicant as failing in the entire examination, and as disqualified for subsequent parts of an examination.

The City of Compton does not discriminate on the basis of race, color, national origin, sex, religion, age, or disability in employment or provisions of services.

Applicants with disabilities who require special testing arrangements must give advanced notice to the Human Resources Department prior to the final filing date.

Recruitment may be conducted on a (a) promotional basis, (b) open-competitive basis, or (c) promotional and open-competitive basis simultaneously. All candidates who attain an overall score of at least 70.00 (open-competitive) and at least 75.00 (promotional) will be placed in rank order on the relevant eligible list(s).

All permanent City employees that attain an overall score of at least 75.00 will be placed on both the promotional eligible list and the open-competitive eligible list. All City employees that attain a score of 70.00 on EACH PHASE of the examination but an overall score of less than 75.00 will be placed on the open-competitive eligible list only. Each eligible list shall remain in effect one (1) year from the date of its establishment unless it is extended, abolished or exhausted. Whenever possible, three (3) names are certified to fill any one (1) vacant position. No candidate may be certified more than three (3) times for any one classified position. When certifying eligible lists to appointing powers, the promotional eligible list takes precedence over the open-competitive eligible list. A department manager's recommendation for employment is subject to the City Manager's approval.

A candidate may, within five (5) days after taking the written examination, file in writing with the City Manager an appeal against any part of the test, citing the item or items against which the appeal is directed, and the reason(s) for such appeal. The Personnel Board will consider appeals from the decisions and ratings of qualifications appraisals (interview) boards if such appeals meet the conditions described in the Personnel Rules and Regulations (Section 6.8).

All examination papers, including the employment application, resume, and other attachments submitted by candidates are the property of the Personnel Board and are confidential records which may be open to inspection only for purposes and under conditions established by the Personnel Board.

In all entrance examinations (open-competitive only) for positions in the Classified Service, veterans who served in the armed forces of the United States during time(s) of war, and who attain an overall passing score in the examination are allowed additional preferential credit in accordance with the Personnel Rules and Regulations. In order to claim veterans' credit, the applicant must submit proof of service and honorable discharge (showing specific dates of service) on a U.S. Military form (DD-214) at the time of application or not later than the final filing date for the examination.

The City's comprehensive fringe benefits program includes: retirement (Public Employees' Retirement System), medical, dental, life and vision insurances, deferred compensation, sick and vacation leaves, after-hours education reimbursement, ride share program, uniform allowance and other provisions.