Workers' Comp Claims Specialist I

City of San Diego; San Diego (CA); On-site; USD 65,000 - 75,000; Full time

Job summary

The City of San Diego is seeking a Workers' Compensation Claims Representative I to investigate, review, evaluate, and administer California workers' compensation claims with responsibilities including medical report review, reserves, and bill approvals. A valid designation as a Claims Adjuster, Experienced Adjuster, or Medical-Only Adjuster is required.

At least one year of professional-level experience is required.

Qualifications

• One year of full-time professional-level experience investigating, adjusting, and settling workers' compensation claims under California law.
• Possession of one of the following valid designations: Claims Adjuster, Experienced Claims Adjuster, or Medical-Only Claims Adjuster per California Code of Regulations.
• For City of San Diego employees, submission of proof of Out of Class Assignment (OCA) if used to meet minimum requirements.

Responsibilities

• Investigate, review, evaluate, and administer workers' compensation claims.
• Review medical reports and set reserves; file documentation and approve medical bills for payment.
• Interview and correspond with claimants, witnesses, attorneys, and physicians; approve claims or recommend denial.
• Represent the City at various workers' compensation and industrial leave claim actions and hearings.
• Perform other duties as assigned.

Job description

The City of San Diego is seeking a Workers' Compensation Claims Representative I to investigate, review, evaluate, and administer California workers' compensation claims with responsibilities including medical report review, reserves, and bill approvals. A valid designation as a Claims Adjuster, Experienced Adjuster, or Medical-Only Adjuster is required.

At least one year of professional-level experience is required.