Verified Job
Work from home
Claims Adjuster Trainee/Claims Adjuster I
Work from home
#784281
Remote / WFH
County of Riverside
Job Description
Job description
The County of Riverside’s Human Resources Department is seeking a Claims Adjuster Trainee/Claims Adjuster I to support the Workers' Compensation Division. The Claims Adjuster Trainee under direct supervision will carry a caseload of workers' compensation claims and will assist in establishing contact with injured workers, conduct investigations, and determine resolution. A California Self Insured Certificate is required for this position.
This is the trainee level class of the series, and under immediate supervision, incumbents receive structured claims casework training and initially handle claims involving minimal investigation and the resolution of simple, critical issues. Incumbents are assigned to perform progressively more responsible investigative and decision-making processes on claims as their training progresses. Incumbents do not have settlement authority, but may have delegated expense and reserve authority consistent with the appropriate claims procedures manual. Failure to successfully complete the structured training and experience requirements and achieve a satisfactory performance evaluation within 12 months of appointment will result in termination.
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.
Claims Adjuster I
This is the first working level class in the series and, under close supervision, incumbents are responsible for performing independent claims casework of average difficulty with responsibility for investigative and decision making functions for claims. Typical casework assigned at this level includes identification, investigation and resolution of claims involving critical issues of liability and damages in the liability claims area or issues of lost time and rehabilitation in the workers' compensation area. Payment, settlement, and reserve authority is consistent with the limits stated in the appropriate claims procedures manual. Incumbents may represent the County in small claims court; may pursue subrogation efforts on behalf of the County; and assist with more complex claims. Incumbents are expected to promote to the journey level Claims Adjuster II class after acquiring the necessary training, experience and IEA certification and demonstrating satisfactory job performance or be terminated.
Claims Adjuster Trainee: $30.54- $43.28
Claims Adjuster I: $37.83 - $53.67
The level at which the position will be filled is at the Department's discretion and is based on candidate qualifications.
Meet the Team!
The Human Resources (HR) Department strives to effectively serve and partner with our community, departments and employees by leveraging best practices and innovation to foster a thriving county.
Claims Adjuster Trainee
• 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.
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.
• 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.Claims Adjuster Trainee
Experience: Considerable clerical experience in an insurance, medical or legal environment providing supporting services to workers' compensation or liability claims adjusters which has included setting up files, obtaining information, sorting and processing of materials; maintaining records; and operating a variety of equipment including computers and calculators.
OR
Experience: Some 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.
Claims Adjuster I
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). Possession of an IEA Certificate with a satisfactory passing grade is required within two years of appointment.
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.
AND
All Options:
A California Self Insured Certificate is required at the time of application. For more information on this certificate click here.
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.Job Competencies:
Work Performance Measures
• Effectively analyze and interpret federal and state laws affecting claims.
• Successfully discern and analyze alternatives in technical situations to assist in problem resolution.
• Participate appropriately in meetings as directed by the Workers' Compensation Officer or Liability Claims Program Supervisor.
• Accurately assess and calculate claim settlement costs.
• Successfully analyze information to determine appropriate strategy.
• Succinctly and clearly develop written reports and recommendations as assigned.
• Skillfully utilize computer and other available technology to maintain claims records, supporting documentation and technical/legal information.
• Meet obligations and commitments.
This recruitment is open to current HR Department Employees only.
Please contact Angela Tavaglione at atavaglione@rivco.org or (951) 966-3590. Please allow 1-2 business days for response.
The County of Riverside’s Human Resources Department is seeking a Claims Adjuster Trainee/Claims Adjuster I to support the Workers' Compensation Division. The Claims Adjuster Trainee under direct supervision will carry a caseload of workers' compensation claims and will assist in establishing contact with injured workers, conduct investigations, and determine resolution. A California Self Insured Certificate is required for this position.
This is the trainee level class of the series, and under immediate supervision, incumbents receive structured claims casework training and initially handle claims involving minimal investigation and the resolution of simple, critical issues. Incumbents are assigned to perform progressively more responsible investigative and decision-making processes on claims as their training progresses. Incumbents do not have settlement authority, but may have delegated expense and reserve authority consistent with the appropriate claims procedures manual. Failure to successfully complete the structured training and experience requirements and achieve a satisfactory performance evaluation within 12 months of appointment will result in termination.
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.
Claims Adjuster I
This is the first working level class in the series and, under close supervision, incumbents are responsible for performing independent claims casework of average difficulty with responsibility for investigative and decision making functions for claims. Typical casework assigned at this level includes identification, investigation and resolution of claims involving critical issues of liability and damages in the liability claims area or issues of lost time and rehabilitation in the workers' compensation area. Payment, settlement, and reserve authority is consistent with the limits stated in the appropriate claims procedures manual. Incumbents may represent the County in small claims court; may pursue subrogation efforts on behalf of the County; and assist with more complex claims. Incumbents are expected to promote to the journey level Claims Adjuster II class after acquiring the necessary training, experience and IEA certification and demonstrating satisfactory job performance or be terminated.
Claims Adjuster Trainee: $30.54- $43.28
Claims Adjuster I: $37.83 - $53.67
The level at which the position will be filled is at the Department's discretion and is based on candidate qualifications.
Meet the Team!
The Human Resources (HR) Department strives to effectively serve and partner with our community, departments and employees by leveraging best practices and innovation to foster a thriving county.
Claims Adjuster Trainee
• 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.
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.
• 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.Claims Adjuster Trainee
Experience: Considerable clerical experience in an insurance, medical or legal environment providing supporting services to workers' compensation or liability claims adjusters which has included setting up files, obtaining information, sorting and processing of materials; maintaining records; and operating a variety of equipment including computers and calculators.
OR
Experience: Some 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.
Claims Adjuster I
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). Possession of an IEA Certificate with a satisfactory passing grade is required within two years of appointment.
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.
AND
All Options:
A California Self Insured Certificate is required at the time of application. For more information on this certificate click here.
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.Job Competencies:
Work Performance Measures
• Effectively analyze and interpret federal and state laws affecting claims.
• Successfully discern and analyze alternatives in technical situations to assist in problem resolution.
• Participate appropriately in meetings as directed by the Workers' Compensation Officer or Liability Claims Program Supervisor.
• Accurately assess and calculate claim settlement costs.
• Successfully analyze information to determine appropriate strategy.
• Succinctly and clearly develop written reports and recommendations as assigned.
• Skillfully utilize computer and other available technology to maintain claims records, supporting documentation and technical/legal information.
• Meet obligations and commitments.
This recruitment is open to current HR Department Employees only.
Please contact Angela Tavaglione at atavaglione@rivco.org or (951) 966-3590. Please allow 1-2 business days for response.
