Rev. 12/97
City of San José
WORKERS' COMPENSATION CLAIMS ADJUSTER II
(1434)
CLASS PURPOSE
Under general direction, performs journey-level work of
considerable difficulty related to Workers' Compensation claims
adjustment. 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 knowledge of Workers' Compensation Laws, both
statutory and judicial in adjusting workers' compensation
claims. Studies and implements applicable changes in
Workers' Compensation Laws, Rules and Regulations.
- Investigates claims and potential claims against the City
for Workers' Compensation; determines appropriateness in
accordance with California Labor Code. Gathers, organizes
and analysis data, reports and other documents to
determine compensability and establish evidence.
- Determines or evaluates liability and sets monetary
reserves within limits.
- Negotiates and approves settlements within prescribed
limits, makes recommendations to Workers' Compensation
Supervisor or Risk Manager for all amounts in excess of
established authority, obtains and prepares Compromise
and Release or Stipulations with request for award.
- Pursues third-party recovery from at-fault parties and
ensures the City's right to third party credit when
applicable.
- Denies claims in the proper manner where investigation
has established that liability against the City does not
exist.
- May represent the City before the Workers' Compensation
Appeals Board.
- Corresponds with medical and legal professionals in an
effort to resolve claims issues. Interprets medical
reports and suggests appropriate treatment.
- Assigns and oversees vocational rehabilitation when
appropriate.
- Works with defense attorneys to prepare suitable defenses
for contested cases.
- Obtains and reviews workers' compensation job analyses to
evaluate an injured employee's ability to return to
regular or modified work.
- Determines return to work process for injured employees
based on medical information obtained by the adjuster.
DISTINGUISHING CHARACTERISTICS
This is the fully experienced level in Workers' Compensation
adjusting work where the incumbent can independently perform
professional services. Incumbents report to a Senior Workers'
Compensation Claims Adjuster.
The specific duties of this class consist of responsible work
in the investigation of workers' compensation claims, accidents
and incidents against the City; performing analysis, review and
adjustment of workers' compensation claims; conducting settlement
negotiations and third-party recoveries.
QUALIFICATIONS
Minimum Knowledge, Skills and Abilities
- Knowledge of modern principles of organization and case
management.
- Knowledge of report writing techniques and the principles
of editing.
- Knowledge of research techniques and their applications
to workers' compensation claims.
Competency Knowledge, Skills and Abilities
- Knowledge of methods and techniques of investigation of
workers' compensation claims.
- Knowledge of workers' compensation claim adjustment
principles.
- Knowledge of Workers' Compensation laws of the State of
California.
- Knowledge of medical terminology.
- Knowledge of legal terminology.
- Knowledge of current trends in Appellate Court decisions.
- Knowledge of City government functions.
- Ability to interpret and apply the provisions of
California Workers' Compensation Laws.
- Ability to collect and analyze pertinent legal and
medical evidence.
- Ability to interview injured employees and witnesses.
- Ability to understand and interpret and apply
instructions, rules and regulations.
- Ability to express oneself, clearly and concisely, both
orally and in writing, and to edit written material.
Education
Successful completion of a Bachelors Degree from an accredited
college or university in Public Administration, Business or
closely related field.
Experience
Two (2) years of workers’ compensation claims adjusting
experience.
Acceptable Substitutions
Two (2) years additional experience with workers’
compensation claims adjusting may be substituted for the degree.
Licenses/Certificates
Possession of a valid California driver's
license.
State of a California Self-Insurance Administrator's
Certificate within one (1) year of appointment.
(7/90), (Rev. 12/97)
1434s001.doc