Workers' Compensation Claims Representative I

The City of San Diego; California; On-site; USD 65,000 - 85,000; Full time

Job summary

The City of San Diego is hiring a Workers' Compensation Claims Representative I. The role investigates, reviews, evaluates, and administers claims under California law, reviews medical reports, sets reserves, and handles documentation.

Candidates must have one year of professional experience in investigating, adjusting, and settling claims and hold a valid designation such as Claims Adjuster, Experienced Claims Adjuster, or Medical-Only Claims Adjuster per California regulations.

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 in accordance with the California Code of Regulations.

Responsibilities

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

Job description

JOB INFORMATION

WORKERS' COMPENSATION CLAIMS REPRESENTATIVE I IS NOT AN ENTRY-LEVEL POSITION. IF YOU DO NOT HAVE A VALID DESIGNATION AS A CLAIMS ADJUSTER, EXPERIENCED CLAIMS ADJUSTER, OR MEDICAL-ONLY CLAIMS ADJUSTER IN ACCORDANCE WITH THE CALIFORNIA CODE OF REGULATIONS, YOU WILL NOT QUALIFY FOR THIS POSITION.

See NOTE(S) below for future wage increases and/or additional compensation opportunities.

APPLICANTS ARE ENCOURAGED TO APPLY TO THE FOLLOWING RELATED RECRUITMENT(S):

• Workers’ Compensation Claims Aide
• Workers’ Compensation Claims Representative II

Workers' Compensation Claims Representative I positions investigate, review, evaluate, and administer workers' compensation claims; review medical reports; set reserves; file documentation; review and approve medical bills for payment; review accident and injury reports; interview and correspond with claimants, witnesses, attorneys, and physicians; approve claims or recommend denial; and represent the City at various workers' compensation and industrial leave claims actions and hearings; and perform other duties as assigned.

Notes:

• Employees in job classifications represented by Municipal Employees Association (MEA) are scheduled to receive the following general wage increases:
  • 3.5% effective 7/1/27
  • 2% effective 7/1/28
  • 2% effective 1/1/29
• Eligible benefitted employees originally hired on or after July 10, 2021, will be automatically enrolled in the San Diego City Employees Retirement System (SDCERS).

EXPERIENCE:

One year of full-time professional-level experience investigating, adjusting, and settling workers' compensation claims covered by California law AND possession of one of the following valid designations: Claims Adjuster, Experienced Claims Adjuster, or Medical-Only Claims Adjuster in accordance with the California Code of Regulations.

Notes:

• Experience working for a third-party administrator, insurance company or self-insured public agency or private company is qualifying.
• Experience working in a law office preparing, negotiating, or settling workers' compensation claims is NOT qualifying.
• City of San Diego employees using Out-of-Class Assignment (OCA) experience to qualify must submit written documentation signed by their appointing authority or payroll specialist, detailing the work performed, dates, and total number of qualifying OCA hours. OCA experience without the required documentation will NOT be considered.

HIGHLY DESIRABLE:

• Possession of a Self Insurance Administrator Certificate issued by the State of California Department of Industrial Relations.