Workers' Compensation Claims Representative 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

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).

You must meet the following requirements on the date you apply, unless otherwise indicated.

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.

REQUIRED DOCUMENTS (MUST SUBMIT WITH APPLICATION)

• Proof of designation as a Claims Adjuster, Experienced Claims Adjuster, or Medical-Only Claims Adjuster in accordance with the California Code of Regulations.
• For City of San Diego employees, proof of out of Class Assignment (OCA), if utilized to meet the minimum requirements.

Required documents should be attached electronically to your application. If you are unable to attach at the time of application submittal, you must submit them as soon as possible via fax: [phone]; or to the Employment Information Center: City of San Diego Personnel Department, 1200 Third Avenue - Suite 300, San Diego, CA 92101. Include your name and the title of the position for which you are applying.

Please ensure all information is complete and accurate as the responses you provide on the supplemental questions will be reviewed using an automated evaluation system. If you are successful in this initial screening process, your application will be reviewed for applicable education, experience, and/or training to ensure all minimum requirements have been met. Successful candidates will be placed on a list which will be used to fill position vacancies during the next six months (180 days). For each vacancy, only those candidates with the most appropriate qualifications will be contacted by the hiring department for an interview.

PRE-EMPLOYMENT REQUIREMENTS

: Employment offers are conditional pending the results of all screening processesapplicable to this position, which may include the following: confirmation of citizenship or legal right to work in the United States; completion of pre-employment medical review and exam (which may include drug and alcohol testing; ...].** etc

All screening processes must be successfully completed before employment begins. A positive test result for alcohol, cannabis/marijuana, illegal drugs, or inadequately explained prescription drugs, or misrepresentation, falsification, or omission of pertinent facts in any step of the screening or selection process, may constitute cause for disqualification or termination of employment. Nothing in this job posting constitutes an express or implied contract for employment with the City of San Diego. Candidates must notify the Personnel Department of any change in their name, mailing address, email address, or phone number, otherwise they may miss employment opportunities.