WORKERS' COMPENSATION CLAIMS ADJUSTER I (1431)

3/4/80

Rev 7/22/83

Rev & Ret 7/15/90

City of San José

WORKERS' COMPENSATION CLAIMS ADJUSTER I (1431)

CLASS PURPOSE

Under direct supervision, performs a variety of Workers' Compensation Insurance benefit claims adjustment work of moderate difficulty such as analysis, reviews, investigations and adjustments. Performs related work as required.

TYPICAL DUTIES AND RESULTS (Any one position may not include all the duties listed, nor do the examples cover all the duties which may be performed.)

Reviews on-the-job injury reports of City employees and determines compensability. Inquires into the causes of accidents and injuries and refers cases to outside investigating firms for in-depth investigation where warranted.
Negotiates cases and authorize settlements of claims within given authority limit; assists attorneys representing the City in the preparation of the litigation files and development of cases.
Adjusts Workers' Compensation claims, including the provision of medical treatment and payment of medical bills, temporary and permanent compensation, and death benefits; contacts claimants, their attorneys, physicians, and vocational rehabilitation counselors, concerning problems with cases; coordinate services and benefits.
Periodically reviews all open cases; determines courses of action and refers cases for closure. Estimates eventual total future cost of each case and periodically reviews and revises where needed.
Counsels disabled employees regarding return to work and possible work re-assignment.
Prepares reports and correspondence. Interacts with other City departments and other agencies involved in Workers' Compensation insurance benefit claims.

DISTINGUISHING CHARACTERISTICS

This is the beginning level general analytic class, where expertise is obtained on the job in order to progress into the higher class of Workers' Compensation Claims Adjuster II. Initially, supervision and training are given in detail, but as an incumbent becomes more capable, he/she works with a higher degree of independence. This class differs from that of Workers' Compensation Claims Adjuster II in that incumbents of the latter perform workers' compensation adjustment work of considerable difficulty.

QUALIFICATIONS

Minimum Knowledges, Skills and Abilities

Knowledge of Workers' Compensation insurance adjustment principles.
Knowledge of the applicable Workers' Compensation laws of the State of California.
Ability to establish and maintain effective working relationships with others.
Ability to perform basic arithmetic calculations.
Ability to speak and write clearly and concisely.
Knowledge of basic medical terminology.

Competency Knowledges, Skills and Abilities

Knowledge of legal terminology regarding Workers' Compensation.
Knowledge of current trends in court decisions and Workers' Compensation Appeals Board cases.
Knowledge of resources available for rehabilitation of disabled employees.
Ability to interpret and apply the provisions of the California Workers' Compensation laws.
Ability to collect and analyze pertinent legal and medical evidence and draw sound conclusions.

Training and Experience

Any combination of training and experience equivalent to successful completion of a Baccalaureate Degree from an accredited college or university in business or public administration or closely related field, or an Associate of Arts/Science degree and two years experience in general claims adjusting.

Licenses/Certificates

Possession of a valid California driver's license.

(Formerly Workers' Compensation Claims Adjuster)

(2897p)