Workers' Compensation Claims Representative II

City of San Diego; San Diego (CA); On-site; USD 80,000 - 110,000; Full time

Job summary

City of San Diego is seeking a Workers' Compensation Claims Representative II with substantial claims investigation and adjustment responsibilities. This role handles complex workers' compensation matters, including pre-trial work, reporting, and hearings representation for the City.

Two years of professional experience and a valid CA designation are required; the position notes wage increases and retirement enrollment for eligible employees, with opportunities for career advancement within

Qualifications

• Two years of full-time professional-level experience investigating, adjusting, and settling workers' compensation claims.
• At least one year of experience handling claims under California law with a valid designation as a Claims Adjuster or Experienced Claims Adjuster.

Responsibilities

• Investigate, adjust, and settle workers' compensation claims; conduct pre-trial investigations and prepare reports.
• Review accident and injury reports; determine and rate employee disabilities; represent the City at hearings.
• Perform other duties as assigned.

Skills

Claims investigation

Claims adjustment

Settlement

Education

CA Claims Adjuster designation

Job description

WORKERS' COMPENSATION CLAIMS REPRESENTATIVE II IS NOT AN ENTRY-LEVEL POSITION. IF YOU DO NOT HAVE A VALID DESIGNATION AS A CLAIMS ADJUSTER OR EXPERIENCED 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 I

Workers' Compensation Claims Representative II positions investigate, adjust, administer, and settle workers' compensation cases; conduct pre-trial investigations and prepare reports; review accident and injury reports; determine and rate employee disabilities; represent the City at various workers' compensation 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

Two years of full-time professional-level experience investigating, adjusting, and settling workers' compensation claims which MUST include at least one year of full-time experience handling claims covered by California law AND a valid designation as a Claims Adjuster or Experienced 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 or Experienced 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.

PRE-EMPLOYMENT REQUIREMENTS

Employment offers are conditional pending the results of all screening processes applicable to this position, which may include the following: confirmation of citizenship or legal right to work in the United States; completion of a pre-employment medical review and exam (which may include drug and alcohol testing); reference checks; and fingerprinting. Fingerprints will be submitted to the Federal Bureau of Investigation and the California Department of Justice for a conviction record report. Certain positions may require additional screening processes, including a polygraph examination and/or background investigation. 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 be 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 to their name, mailing address, email address, or phone number, otherwise they may miss employment opportunities.