SENIOR WORKERS' COMPENSATION CLAIMS ADJUSTER (1433)

7/11/90

City of San José

SENIOR WORKERS' COMPENSATION CLAIMS ADJUSTER (1433)

CLASS PURPOSE

Under general direction, supervises journey level adjusters and performs work of considerable difficulty in adjusting, analyzing, investigating and resolving workers' compensation claims cases. 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.)

Applies working knowledge of Workers' Compensation Laws, both statutory and judicial in adjusting the most complex workers' compensation claims.
Studies and implements applicable changes in Workers' Compensation Laws, Rules and Regulations.
Trains, guides and supervises the work of journey level adjusters.
Maintains litigation files.
Conducts interviews, oral or recorded, with injured employees, supervisors, witnesses and physicians to determine compensability of the injury and/or to resolve workers' compensation claims.
Determines potential liability and establishes reserves on assigned cases; reviews recommended reserves of lower level adjusters.
Prepares litigations files, develops claims case, negotiates settlements within prescribed authority and prepares settlement documents.
Reviews and approves settlements prepared by lower level adjusters.
Represents the City before the Workers' Compensation Appeals Board and at formal and informal rehabilitation conferences.
Assists Workers' Compensation attorneys with pre-trial discovery.
Explains changes in the law and conducts training seminars for departments and divisions. Conducts training sessions for key personnel as needed.
Pursues third-party recovery from at-fault parties and ensures the City's right to third-party credit when applicable.
Corresponds with medical and legal professionals in an effort to resolve claims issues. Interprets medical reports and suggests appropriate treatment.
Participates with others in analyzing and evaluating information and issues; offers guidance and counseling in the resolution of Workers' Compensation claims.
Obtains and reviews workers' compensation job analyses to evaluate an injured employee's ability to return to regular or modified work.
Prepares reports and settlement authorization requests for Council.
Monitors cost controls in Workers' Compensation program by ensuing the accuracy and completeness of lower level adjuster's case files and by addressing and resolving the most complicated Workers' Compensation cases filed against the City.

DISTINGUISHING CHARACTERISTICS

This class is the second level in the Workers' Compensation Claims Adjuster series. An incumbent in this class trains, leads and supervises the lower level adjusters.

QUALIFICATIONS

Minimum Knowledges, Skills and Abilities

Knowledge of Workers' Compensation principles, practices and procedures.
Knowledge of California Workers' Compensation Laws.
Knowledge of current Appellate Court Decisions.
Knowledge of medical and legal terminology.
Ability to analyze pertinent legal and medical evidence.
Ability to interview injured employees, supervisors and witnesses.
Ability to understand, interpret and apply directions, rules and regulations.
Ability to communicate clearly and concisely, both orally and in writing, and to edit written material.

Competency Knowledges, Skills and Abilities

Knowledge of theory, principles, practices and techniques of public administration and public relations.
Ability to interpret provisions of Workers' Compensation Legislation and Appellate Court decisions.
Ability to communicate and interact in situations requiring tact, instruction and persuasion.
Ability to train and direct staff.
Ability to conduct seminars and meetings on Workers' Compensation issues for other departments.

Training and Experience

Any combination of training and experience equivalent to completion of a Bachelor Degree from an accredited college or university in Business Administration, Public Administration or a related degree and four (4) years progressively responsible experience in the investigation and resolution of Workers' Compensation indemnity claims.

Licenses/Certificates

Possession of a valid California driver's license. State of California Self-insurance Plans Administration Certificate is required. Completion of the certificate program in Workers' Compensation Claims Administration or the Self-insurance Claims Administration issued by the Insurance Education Association or a Certificate for Completion of the ARM or AIC program issued by the Insurance Institute of America is desirable.

(2983P/1020P)