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NEOGOV · 4 weeks ago

Workers' Compensation Claims Adjuster III

San Jose Metropolitan Area, CA

Full-time

Onsite

Senior Level

$113K/yr - $138K/yr

5+ years exp

NEOGOV is part of the County of Santa Clara, seeking a Workers' Compensation Claims Adjuster III to manage and adjust claims for County employees seeking Workers' Compensation Benefits. The role involves training lower-level adjusters and serving as a subject matter expert on complex claims while ensuring compliance with California Workers' Compensation laws.

GovTechHuman ResourcesInformation TechnologySoftware

No H1B

Responsibilities

Trains, reviews and evaluates the work of lower levels of Workers' Compensation Claims Adjusters

Serves as subject matter expert on the more complex Workers' Compensation Claims

Adjusts on-the-job injury claims for County employees and determines compensability and reserve requirements

Conducts interviews with claimants, witnesses, supervisors and physicians regarding claims to ascertain the creditability of the claims

Identifies need for modified or alternate work accommodations or retraining services

Requests and records substantiating documentation from physicians, departments and witnesses

May prepare the litigation file, develop the case and negotiate Compromise and Release agreements or stipulations and/or assists counsel in these functions

May represent the County before the Workers' Compensation Appeals Board

Makes provisions for medical treatment, payment of medical bills and all compensation benefits

Manages and controls caseload through periodic review of all open cases and determines course of action including case closures

Initiates investigation of accidents or injury causes and the status of disabled employees in order to determine facts and evidence to support the satisfactory disposition of cases

Prepares reports and correspondence

Performs related work as required

Qualification

Workers' Compensation principlesCalifornia Workers' Compensation LawsClaims adjusting experienceMedicalLegal terminologyWorkers' Compensation Appeals BoardRating Permanent DisabilitiesTrainingEvaluating staffJudgmentEffective communicationDecision makingRelationship building

Required

Possession of a Bachelor's Degree or a total of four (4) years of specialized workers' compensation programs and courses and/or experience comparable to a Claims Technician with Santa Clara County

Possession of a State of California Self-Insurance Certificate

Completion of at least 160 hours of workers' compensation training, of which at least 120 hours shall be conducted in a classroom with an instructor, completed within a 12 month period

Have worked five (5) years in the last eight (8) years of on-the-job experience adjusting California workers' compensation claims, or supervising claims adjusters handling workers' compensation claims

Possession of a valid California driver's license prior to appointment and the ability to qualify for and maintain a County Driver's Permit

Workers' Compensation Claims Adjusters III are required to complete Post Designation Training of thirty (30) hours every two (2) years

Knowledge of Workers' compensation principles and policies

Knowledge of Provisions of the Workers' Compensation Laws of California

Knowledge of Practices and procedures of the Workers' Compensation Appeals Board

Knowledge of Medical and legal terminology

Knowledge of Current trends in decisions of the courts and Workers' Compensation Appeals Board on compensation cases

Knowledge of The effective use of the Schedule for Rating Permanent Disabilities

Knowledge of Resources available for providing modified or alternate work accommodations or retraining of the injured or disabled

Knowledge of Common office computer applications such as word processing, spreadsheet and databases

Knowledge of Office practices and procedures

Ability to Exercise good judgment in interpreting and applying the provisions of the Workers' Compensation Laws

Ability to Collect and analyze legal and medical evidence and draw sound conclusions

Ability to Establish and maintain cooperative and effective working relationships with those contacted in the course of work

Ability to Oversee the day-to-day operations of a work unit

Ability to Speak and write effectively

Benefits

Comprehensive first-class medical, dental, and vision benefits plans for County employees and their dependents, including plans with no deductibles, no co-pays, no co-insurance, and no prescription drug co-pays

Generous paid time off with significant vacation, sick time, and 13 paid County holidays annually

Robust retirement plans including a 457(b) Deferred Compensation Plan and the CalPERS pension plan

Health Flexible Spending Account (HFSA)

Dependent Care Assistance Program (DCAP)

Employee Childcare Assistance Plan

Life Insurance

Accidental Death and Dismemberment (AD&D) Insurance

Long-Term Disability insurance

California State Disability Insurance

Integration with Leave

Employee Assistance Program (EAP)

Employee Wellness Program