Workers' Compensation Claims Adjuster I/II - County of Riverside
Riverside, CA 92501
About the Job
The County of Riverside's Human Resources Department is seeking a Claims Adjuster I/II to support the Workers' Compensation Division.
This position will carry a caseload of workers' compensation claims and will be responsible for establishing contact with injured workers, conducting Arising Out of Employment (AOE) and Course of Employment (COE) investigations, and determining if the injuries or illnesses are compensable. The Claims Adjuster II will also review claims for subrogation, prepare settlement documents, and calculate and approve benefit payments.
Positions in this class series report to the Workers' Compensation Officer and are characterized by responsibility to perform claims casework for the County's various self-insurance programs including general liability, medical malpractice and workers' compensation claims. Incumbents, within delegated settlement authority, bring such cases to resolution by recommending the acceptance or denial of claims and to adjust cases involving the County's various self-insured programs from the initial report to final resolution.
The level at which the position will be filled is at the Department's discretion and is based on candidate qualifications.
Required: A California Self-Insured Certificate issued by the State of California Office of Self-Insurance Plans (OSIP) is required at the time of application.
Meet the Team!
The Human Resources Department seeks and develops talented professionals that fit a highly engaged and collaborative culture.
EXAMPLES OF ESSENTIAL DUTIES
Claims Adjuster I
• Workers' Compensation Claims: Reviews, investigates and processes reports and claims concerning on-the-job injuries or job-related illness of County employees for claims filed against the County and determines if the illness or injury is compensable; arranges disability evaluation appointment and maintains medical control; responds to inquiries from excess insurance carriers, doctors, and legal professionals.
• Prepares cases for legal defense; assists in the preparation of appeals cases before the Workers' Compensation Appeals Board; secures documentary evidence of births, deaths, marriages and divorces in fatality cases.
• Evaluates advisory and informal ratings as a basis for claims settlement; rates permanent disabilities pursuant to California Rating Schedule; approves payment for medical services, temporary disability and permanent disability awards subject to delegated authority as determined by the Risk Management Division Manager.
• Prepares subrogation recovery cases; analyzes investigative and police reports; arranges special investigations and medical examinations.
• Develops, maintains, and analyzes statistical data on claims expenditure trends and provides appropriate report and recommendations; stays abreast of current Workers' Compensation and civil claims litigation.
• Senior Workers' Compensation Claims: Assigns and reviews the work of Adjusters and Technicians; trains and provides technical assistance to new and journey-level Adjustors.
• Examines and adjusts third party claims, via contract, for County Departments with special programs.
• Coordinates the County's defense appeal for safety disability retirement denials and makes presentation before the retirement appeals board.
• Assists the Workers' Compensation Officer with the implementation of special programs such as in-house litigation; determines which claims for adjudication will be litigated by in-house staff.
• Assists in the supervision and maintenance of statistical and budget records and participates in studies of industrial accident matters.
• Gathers and reviews data, reports and other claim documentation; requests clarifying or additional information; reviews status and performs necessary follow up.
• Conducts investigations to determine circumstances involved in claims against the County; including interviewing witnesses and inspecting the scene of accidents, injuries or property damage; prepares investigative report of findings.
• Conducts interviews with parties responsible for damage to County property and injuries to County employees to ensure collection of payments; contacts public and private organizations/agencies to obtain collections information; recommends actions necessary to enforce collections including court actions or liens.
• Represents the County in small claims actions.
• Prepare reports of costs and status on active and closed claims.
• May authorize subrogation, court actions or liens when collections can not be obtained by other means; reviews and makes recommendations for suspension, modification, garnishment or other legal actions; corresponds with attorneys, insurance carriers and others; interprets legal procedures involved in the collection or subrogation accounts.
• Consults with attorneys to prepare cases for litigation.
• Serves as custodian of records; provides subpoenaed records and attests to their validity.
• May assign and review the work of others and provide training to new employees.
• Assists the program supervisor to develop and maintain claims records and computer record keeping systems; assures accuracy conformance to policies and procedures and accessibility of claims records.
• Assists attorneys in the preparation of complex case for litigation ensuring the availability and accuracy of all necessary documentation.
• Assigns and reviews the work of Adjusters and Technicians; trains and provides technical assistance to new and journey-level Adjustors.
Claims Adjuster II
Workers' Compensation Claims:
• Reviews, investigates and processes reports and claims concerning on-the-job injuries or job-related illness of County employees for claims filed against the County and determines if the illness or injury is compensable; arranges disability evaluation appointment and maintains medical control; responds to inquiries from excess insurance carriers, doctors, and legal professionals.
• Prepares cases for legal defense; assists in the preparation of appeals cases before the Workers' Compensation Appeals Board; secures documentary evidence of births, deaths, marriages and divorces in fatality cases.
• Evaluates advisory and informal ratings as a basis for claims settlement; rates permanent disabilities pursuant to California Rating Schedule; approves payment for medical services, temporary disability and permanent disability awards subject to delegated authority as determined by the Risk Management Division Manager.
• Prepares subrogation recovery cases; analyzes investigative and police reports; arranges special investigations and medical examinations.
• Develops, maintains, and analyzes statistical data on claims expenditure trends and provides appropriate report and recommendations; stays abreast of current Workers' Compensation and civil claims litigation.
Senior Workers' Compensation Claims:
• Assigns and reviews the work of Adjusters and Technicians; trains and provides technical assistance to new and journey-level Adjustors.
• Examines and adjusts third party claims, via contract, for County Departments with special programs.
• Coordinates the County's defense appeal for safety disability retirement denials and makes presentation before the retirement appeals board.
• Assists the Workers' Compensation Officer with the implementation of special programs such as in-house litigation; determines which claims for adjudication will be litigated by in-house staff.
• Assists in the supervision and maintenance of statistical and budget records and participates in studies of industrial accident matters.
MINIMUM QUALIFICATIONS
Claims Adjuster I
$34.98 - $49.62 Hourly
$72,759.65 - $103,205.86 Annually
CertificateRequired: A California Self-Insured Certificate issued by the State of California Office of Self-Insurance Plans (OSIP) is required at the time of application.
Experience: Considerable journey-level experience reviewing and processing Workers' Compensation, on-the-job injuries, job-related illnesses, physical disability, personal injury, medical malpractice or property damage liability claims including investigating, adjusting and settling a wide variety of claims. For employees assigned to the Workers' Compensation Unit, must have achieved the level of Designated Claims Adjuster (as defined by California Code of Regulations, Title 10, Chapter 5, Subchapter 3) by possessing one of the following. 1) Working 5 out of the last 8 years as a California Worker's Comp Claims Adjuster, 2) Has worked continuously in California adjusting claims since passing the Self-Insurance Test, or 3) Has passed the Self-Insurance test in the last 2 years.
Claims Adjuster II
$41.17 - $58.44 Hourly
$85,630.69 - $121,545.63 Annually
CertificateRequired: A California Self-Insured Certificate issued by the State of California Office of Self-Insurance Plans (OSIP) is required at the time of application.
Experience: 4 years of e xtensive journey-level experience reviewing and processing Workers' Compensation, on-the-job injuries, job-related illnesses, physical disability, personal injury, medical malpractice or property damage liability claims including investigating, identification and investigation of fraud cases, adjusting and settling a wide variety of claims. For employees assigned to the Workers' Compensation Unit, candidates must have achieved the level of Experienced Claims Adjuster (as defined by California Code of Regulations, Title 10, Chapter 5, Subchapter 3) defined as possessing one of the following: 1) Working 5 out of the last 8 years as a California Worker's Comp Claims Adjuster, 2) Has worked continuously in California adjusting claims since passing the Self-Insurance Test, or 3) Has passed the Self-Insurance test in the last 2 years.
All Levels
Knowledge of: State of California Labor Code, Workers' Compensation Law and rules and regulations (Title 8); Applicable case law of leading decisions of the Workers' Compensation Appeals Board, Court of Appeals, and Supreme Court regarding workers' compensation cases; Medical terminology, anatomy and technical terminology used in medical and legal fields regarding industrial cases; Jurisdiction, functions and procedures of the Workers' Compensation Appeals Board; Vocational rehabilitation and procedures as it applies to Workers' Compensation; Reserving practices and procedures; in-house litigation procedures; WCAB procedures; and hearing processes.
Knowledge of: Practices, techniques and methodologies used in claims investigation, evaluation, adjustment and settlement; Basic rules, regulations, and laws regarding personal and property liability; Principles and techniques of analytical data collection; Principles of insurance reserving, risk and experience analysis and statistical record keeping; Basic mathematics including valuation and depreciation; Computer applications programs and equipment to effectively gather, maintain and report claims data.
Ability to: Communicate, orally and in writing, effectively with a wide variety of people contacted in the course of work; Interpret and apply complex rules, regulations and memoranda of understanding; Establish and maintain cooperative and effective relationships with a broad range of professional staff including attorneys and related legal staff, department heads and managers and all those contacted during the course of performing professional responsibilities; Collect, interpret and evaluate data, develop alternatives and make appropriate recommendations within established guidelines; analyze problems and take effective courses of action; Interpret laws, regulations, and insurance policies; Make accurate mathematical computations; Prepare and present effective written and oral reports and presentations; Maintain professional credibility.
SUPPLEMENTAL INFORMATION
Hybrid Telework and flexible schedule may be available after training requirements have been successfully completed.
Other Requirements
License: A valid California Driver's License is required at the time of appointment or the ability to arrange transportation for field travel.
The incumbent may be required to use a personal vehicle and provide verification of auto insurance coverage as required by the County of Riverside.
All applicants must include a copy of their completed certificates required to qualify. Applicants who fail to provide information demonstrating they possess the position requirements may not be considered further in the application process.
GENERAL INFORMATION
For specific questions regarding this position, contact Angela Tavaglione at atavaglione@rivco.org .
If you are experiencing technical problems, you may contact the governmentjobs.com applicant support desk Monday through Friday, 6 am to 5 pm Pacific Time at support@governmentjobs.com or toll-free 1-855-524-5627.
________________________________________________________________________________________
APPLICATION INFORMATION
Veteran's Preference
The County has a Veterans Preference Policy applicable to new hires. To qualify, upload a copy of your (or your spouse's) Member-4 Form DD-214 indicating dates of service, and a copy of your spouse's letter of disability (if applicable) with your application. For privacy reasons, it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans' preference.The Veterans Preference Policy, C-3 is available here: https://rivcocob.org/board-policies
Reasonable Accommodations
The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation, please visit the Disability Access Office web page located at: https://rc-hr.com/disability
Proof of Education
If using education to qualify or when requested by the recruiter, upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.
If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services ( NACES ) or Association of International Credential Evaluators, Inc. ( AICE ).
Equal Opportunity Employer
The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition (cancer and genetic characteristics), genetic information, or denial of medical and family care leave, or any other non-job-related factors.
Pre-Employment
All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation, which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A pre-employment physical examination and background check may be required.
Probationary Period
As an Approved Local Merit System, all County of Riverside employees, except those serving "At Will," are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding, County Resolution, or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.
General Information
Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.
Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume, as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.
Please read and follow any special application instructions on this posting. Click the 'Apply' link located on this page to submit your application. For additional instructions on the application process, examinations, Veteran's preference, pre-employment accommodation or other employment questions, please refer to our web site, www.rc-hr.com .
If you are experiencing technical problems, you may contact the governmentjobs.com applicant support desk Monday through Friday, 6 am to 5 pm Pacific Time at support@governmentjobs.com or toll-free 1-855-524-5627.
MEDICAL/DENTAL INSURANCE: A Flexible Benefit Credit is provided on a monthly basis as governed by the Management Resolution or applicable bargaining unit. Vision coverage is provided through Vision Service Plan (VSP) at no cost to employee or eligible dependents.
Note: Employees on assignment through the Temporary Assignment Program (TAP) receive different benefits. See the list here .
MISCELLANEOUS RETIREMENT: County of Riverside has three retirement Tiers through the California Public Employees' Retirement System (CalPERS).
- Tier I (Classic Member - Formula 3% @ 60): Applicable to current and former County of Riverside local miscellaneous employees hired prior to 08/24/2012 and did not withdraw CalPERS contributions. The employee contribution is eight (8%) percent.
- Tier II (Classic Member - Formula 2% @ 60): Applicable to local miscellaneous employees 1) hired after 08/23/2012 through 12/31/2012; 2) Previously employed with another CalPERS contracting public agency or a reciprocal retirement system, with a break in service of less than six months between the separation date with the previous employer and the appointment date with the County of Riverside. The employee contribution is seven (7%) percent.
- Tier III (PEPRA New Member - Formula 2% @ 62): Applicable to CalPERS local miscellaneous new members hired on or after the implementation of the Public Employees' Pension Reform Act of 2013 (PEPRA) which took effect January 1, 2013. Effective July 1, 2023 employee contributions are 7.25% and will increase to 7.75% effective July 1, 2024.
A new member is defined as any of the following:
CalPERS refers to all members that do not fit within the definition of a new member as "classic members".
Contribution rates are subject to change based on the County of Riverside annual actuarial valuation.
Note:
This summary is for general information purposes only. Additional questions regarding retirement formulas can be sent to retirement@rivco.org or by calling the Benefits Information Line at (951) 955-4981,
Option 2.
If you have prior service credit with another CalPERS agency or within agencies, please contact CalPERS at (888) 225-7377 to determine which retirement tier would be applicable to you. CalPERS is governed by the Public Employees' Retirement Law. The Retirement Law is complex and subject to change. If there's any conflict between this summary and the law, the law will prevail over this summary.
DEFERRED COMPENSATION: Voluntary employee contribution with a choice between two 457 deferred compensation plan options.
401(a) MONEY PURCHASE PLAN: County contribution of $50 per pay period towards choice between two 401(a) plan providers.
ANNUAL LEAVE (Bi-Weekly Accrual):
0 < 36 months = 8.92 Hours
36 to <108>108 or more months = 12.00 Hours
Maximum Annual Leave accumulation is 1,800 hours. Employee may receive pay in lieu of up to 80 hours per calendar year. Agency/Department Head may approve an additional 80 hours.
HOLIDAYS: Normally 12 paid holidays per year.
BEREAVEMENT LEAVE: 5 days (3 days are County paid; 2 days can be taken through use of accrued leave balances).
BASIC LIFE INSURANCE: $50,000 of term life coverage. Premiums are paid by the County. Additional Supplemental Life plan is available for employee purchase.
LONG-TERM DISABILITY (LTD): Benefit pays 66.67% of earnings to a maximum of $10,000 per month; 30-day waiting period; pays to age 65. Benefit can be coordinated with other available leave balances to provide up to 100% of pay.
POST RETIREMENT MEDICAL CONTRIBUTION: A monthly contribution is made by the County towards retiree health insurance offered through the County as governed by the Management Resolution or applicable bargaining unit.
OTHER: There may be other benefit provisions as specified in the applicable Memorandum of Understanding, Management Resolution, or Salary Ordinance. Please contact the recruiter listed on the job posting directly for more information.
