$54.79-$66.59 Hourly / $9,497.00-$11,542.00 Monthly / $113,958.00-$138,502.00 Yearly
According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this job code and are not intended to be an inclusive list.
When assigned to Claims Adjuster Supervisor:
1. Receives and reviews all incoming workers' compensation claims to determine complexity and assign to appropriate claims adjusting staff.
2. Advises claims adjuster, claims assistants, and support staff on appropriate claims handling techniques.
3. Provides direct claims handling of catastrophic cases, death cases, and confidential complex cases.
4. Serves as the liaison for the workers' compensation coordinators of the client departments.
5. Serves as the workers' compensation technical expert to advise staff on changes and applicability of workers' compensation laws.
6. Audits the work product of claims adjusters to ensure compliance with applicable laws, and departmental best practices.
7. Generates statistical reports and completes analysis of data.
8. Works with the City Attorney's office on litigation strategies for complex claims.
9. Reviews all self-imposed penalties to determine liability and authorizes payment.
10. Authorizes medical treatment for complex medical cases.
11. Reviews the assignment of Qualified Medical Examiners on complex cases.
12. Works collaboratively with Medical Coordinator to establish medical protocols and member panels.
13. Advises Medical Coordinator on issues related to medical clinic operations.
14. Provides ongoing system support to claims staff.
15. Accurately estimates the potential claim costs (reserves) on complex cases.
16. Provides technical assistance to claims adjusters in determining permanent disability award calculations.
17. Directs the claims investigation on complex claims.
18. Negotiates case settlement with injured workers, attorneys, and interested parties.
19. Provides daily supervision, guidance, coaching, and mentoring to assigned staff.
20. Completes ongoing performance evaluations of all assigned staff.
21. Provides specialized technical training, as needed, to staff.
22. Performs related duties and responsibilities as assigned.
When assigned to Vocational Rehabilitation Coordinator:
1. Reviews all workers' compensation claims in which the injured worker is eligible for vocational rehabilitation services.
2. Ensures that proper and timely notices of vocational rehabilitation benefits eligibility are provided to injured workers.
3. Coordinates the development and implementation of vocational rehabilitation services for injured workers with qualified rehabilitation representatives.
4. Provides technical vocational rehabilitation advice and training to claims adjusting staff.
5. Identifies transitional work options in conjunction with client departments for injured employees participating in vocational rehabilitation services.
6. Audits the services and programs provided by qualified rehabilitation representatives to ensure program compliance and service levels.
7. Develops statistical reports and performs data analysis.
8. Represents the City interests related to vocational rehabilitation issues in proceedings before the Workers' Compensation Appeals Board and in formal and informal vocational rehabilitation conferences.
9. Serves as the liaison to client departments on issues related to the vocational rehabilitation program.
10. Performs related duties and responsibilities as assigned.
Knowledge of: State of California Labor Code applicable to Workers' Compensation or vocational rehabilitation, industry accepted practices, policies, and procedures for the operation of the workers' compensation program or the delivery of vocational rehabilitation services, and medical terminology.
Ability to: analyze investigative reports and medical documents; accurately calculate complex disability ratings and awards; supervise, review, train, coach, and evaluate the technical work of personnel and contractors; communicate in writing in a clear and concise manner using correct grammar, vocabulary, spelling and sentence structure; conduct effective interviews, and speak in a clear, concise, organized, relevant, and understandable manner; establish and maintain effective working relationships, deal courteously and tactfully, and contact and assist employees, departmental personnel, and representatives from outside agencies and organizations; and use a computer system and related software.
When assigned to Claims Adjuster Supervisor: 1. Four (4) years of verifiable experience adjusting workers' compensation claims; AND 2. Possession of a Self Insurance Administrator's Certificate issued by the State of California, Department of Industrial Relations.
When assigned to Vocational Rehabilitation Coordinator: 1. Four (4) years of verifiable experience providing vocational rehabilitation services for workers' compensation claims; AND 2. Possession of a valid certification as a Certified Rehabilitation Counselor (CRC) issued by the Commission on Rehabilitation Counselor Certification.
Note: Possession of a valid certification as a Certified Disability Management Specialist (CDMS) or as a Certified Case Manager (CCM) issued by the Certification of Disability Management Specialists Commission is preferred.
Essential duties require the following physical skills and work environment: Ability to work in a standard office environment.