County of Santa Clara · 3 weeks ago
Workers' Compensation Claims Adjuster III
Santa Clara County, CA
Full-time
Onsite
Mid, Senior Level
5+ years expCounty of Santa Clara is seeking a Workers' Compensation Claims Adjuster III to analyze, review, investigate, and adjust claims submitted by County employees for Workers' Compensation Benefits. The role involves training lower-level Claims Adjusters, serving as a subject matter expert, and managing a caseload of on-the-job injury claims.
AssociationCommunitiesGovernment
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
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
Company
County of Santa Clara
The mission of the County of Santa Clara is to plan for the needs of a dynamic communit
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Analilia Garcia, DrPH, MPH
Chief Equity & Inclusion Officer
Anushka Tadikonda
Founder of the YTF Gender Equity Sub-Committee
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