Claims Examiner

Job Title

Workers' Compensation Claims Examiner

Job Description

Under general supervision, examines and adjusts claims for Workers' Compensation benefits; monitors claim expenditures; communicates with physicians, supervisors, employees and attorneys regarding illness or injury related to employment; and performs other related duties.

Supervision Received/Exercised

Works under the general supervision of the Risk Manager; does not exercise supervisory responsibility.

Primary Duties and Responsibilities

The following essential functions are those that are critical, integral, necessary, crucial, primary and fundamental to the job. Incumbents who possess the requisite skill, experience, education, and other job-related requirements of a position are expected to perform the essential functions of the job with or without a reasonable accommodation.

• Reviews, examines and adjusts Workers' Compensation claims.
• Receives and records all claims and determines compensability.
• Authorizes medical treatment and/or change of physician utilizing California State Workers' Compensation Law.
• Computes and authorizes payments according to California Labor Code, including medical bills, temporary and permanent disability payments.
• Advises employees and dependents of entitlement to Workers' Compensation benefits under state law and City policies.
• Arranges special investigations and medical examinations including return to work exams.
• Advises departments regarding procedures and reporting deadlines involving work related injuries.
• Contacts injured employee to explain benefits and legal rights under the Labor Code.
• Prepares subrogation and litigation cases and corresponds with doctors and attorneys on litigated cases.
• Serves as custodian of records; produces record and attests to validity under the direction of the court by subpoena.
• Compiles pertinent facts, makes thorough analyses, and arrives at sound decisions.
• Maintains and enforces all aspects of security and confidentiality of records and information.
• Performs other duties as assigned or required.

Minimum Qualifications

Education and Experience:

Possession of a Bachelor's degree from an accredited college or university in Business Administration or a related field, AND two (2) years of experience adjusting workers' compensation claims with a public agency or third-party administrator; OR an equivalent combination of education and experience.

Required Licenses or Certifications:

·Must possess a valid California Class C Driver's License.

·Workers' Compensation Certificate of Insurance.

Required Knowledge of:

·City organization, operations, policies and procedures.

·City Code, City Ordinances, and Standard Operating Manual.

·State of California Labor Code and Workers' Compensation law.

·Medical terminology, anatomy, and technical terminology used in the medical profession related to the cause and treatment of occupational injuries and diseases.

·Investigative techniques, methods and procedures.

·Vocational rehabilitation processes and programs.

·MS Office computer applications.

Required Skill in:

·Compiling pertinent facts, making thorough analyses or Workers' Compensation claims and arriving at sound decisions.

·Understanding, interpreting and applying State Labor Code, Workers' Compensation Law, and City regulations.

·Establishing and maintaining cooperative working relationships with co-workers.

·Operating a personal computer utilizing a variety of business software.

·Effective communication, both verbal and written.

Physical Demands / Work Environment:

·Work is performed indoors in an office setting.

·Work requires frequent light lifting, sorting, filing, typing and driving.

·Moderate finger dexterity and near vision is required.

May be exposed to minor amounts of dust.

Internal applicants must use their personal email to apply, as City of Compton work emails will not be accepted for job applications. While we cannot prevent applicants from using their work email, the City is not responsible for missed communications due to system outages, firewall restrictions, employee leave, or any other technical or accessibility issues affecting City email accounts. All applicants must meet the minimum qualifications for the position and submit all required documents -such as licenses, certifications, and proof of education- outlined in the job posting. Incomplete applications, including those missing any required documentation, will not be considered. Please note: Only the first 50 applications received that best meet the qualifications and needs of the department will be invited to continue in the hiring process.

The purpose of this examination is to establish an eligible list from which vacant position(s) may be filled. Phase one (1) is a written examination (weighted 50%) which will measure all or portions of the above knowledge, and skills. Phase two (2) is an oral examination (weighted 50%) that will be administered by an appraisal panel to evaluate professional qualifications, background and suitability. A passing score for each phase is 70%. Each candidate will be notified via e-mail of their status at each step of the recruitment. The City of Compton reserves the right to utilize alternative testing methods, if deemed necessary. Failure in one phase of the examination shall be grounds for declaring the applicant as failing in the entire examination, and as disqualified for subsequent parts of an examination.

The City of Compton does not discriminate on the basis of race, color, national origin, sex, religion, age, or disability in employment or provisions of services. Applicants with disabilities who require special testing arrangements must give advanced notice to the Human Resources Department prior to the final filing date.

Recruitment may be conducted on a (a) promotional basis, (b) open-competitive basis, or (c) promotional and open-competitive basis simultaneously. All candidates who attain an overall score of at least 70.00 (open-competitive) and at least 75.00 (promotional) will be placed in rank order on the relevant eligible list(s).

A candidate may, within five (5) days after taking the written examination, file in writing with the City Manager an appeal against any part of the test, citing the item or items against which the appeal is directed, and the reason(s) for such appeal. The Personnel Board will consider appeals from the decisions and ratings of qualifications appraisals (interview) boards if such appeals meet the conditions described in the Personnel Rules and Regulations (Section 6.8).

All examination papers, including the employment application, resume, and other attachments submitted by candidates are the property of the Personnel Board and are confidential records which may be open to inspection only for purposes and under conditions established by the Personnel Board.

In all entrance examinations (open-competitive only) for positions in the Classified Service, veterans who served in the armed forces of the United States during time(s) of war, and who attain an overall passing score in the examination are allowed additional preferential credit in accordance with the Personnel Rules and Regulations. In order to claim veterans' credit, the applicant must submit proof of service and honorable discharge (showing specific dates of service) on a U.S. Military form (DD-214) at the time of application or not later than the final filing date for the examination.

The City's comprehensive fringe benefits program includes: retirement (Public Employees' Retirement System), medical, dental, life and vision insurances, deferred compensation, sick and vacation leaves, after-hours education reimbursement, ride share program, uniform allowance and other provisions.

Why Work for the City of Compton? We are proud to offer a competitive and comprehensive benefits package designed to support your well-being, financial security, and career growth, including:

• CalPERS Retirement – Secure pension through the California Public Employees' Retirement System
• Lifetime Medical Coverage for Retirees – Fully funded by the City after 5 years of service with CalPers
• CalPERS Health Benefits Program – Choice of 10 health plans, with City-paid premiums for employees and eligible dependents (up to the annual Kaiser family rate)
• Employer-Paid Vision and Dental Insurance – For both employees and eligible dependents
• Employer-Paid Life Insurance – Offered through UNUM
• Flexible Spending Accounts (FSA) – For healthcare and dependent care expenses through American Fidelity
• Employee-Sponsored Supplemental Benefits – Optional coverage such as life, disability, and accident insurance
• Generous Paid Time Off – Vacation, sick leave, and 16* paid holidays per year
• 4/10 Flexible Work Schedule – Most Administrative roles based at City Hall enjoy a 4-day