Workers' Compensation Claims Representative

With supervisor approval, incumbents may be eligible for intermittent remote work; however, they must physically reside within the State of California with the ability to report to Sacramento-based physical worksites daily if required.
Under general supervision, the Workers' Compensation Claims Representative performs a wide variety of responsible duties in claims adjusting related to the City's self-administered Workers' Compensation Program; provides timely Workers' Compensation benefits pursuant to State of California laws; investigates, evaluates, and settles Workers' Compensation claims against the City of Sacramento; attends mandatory settlement conferences, court hearings, and meetings.
DISTINGUISHING CHARACTERISTICS
This exempt classification is populated with multiple incumbents. The Workers' Compensation Claims Representative performs the entire range of specialized duties requiring a thorough knowledge of all aspects of the Workers' Compensation Program. When filled from the outside, significant prior experience in adjusting Workers' Compensation claims is required.
SUPERVISION RECEIVED AND EXERCISED
General supervision is provided by a Workers' Compensation Claims Supervisor or higher-level management staff.The following duties are typical for this classification. Incumbents may not perform all the listed duties and/or may be required to perform related duties as needed:

• Reviews accident and injury reports and Doctor's First Report of Injury forms to determine proper actions under Workers' Compensation laws and regulations; obtains background information; and opens and adjusts claims; pays temporary disability, permanent disability, and life pension benefits to injured employees; or, pays death benefits to dependents; reviews and pays related medical bills; reviews and pays expenses incurred to defend the City in contested claims; and verifies mileage payment requests, pharmacy reimbursements, and other bills.
  
• Establishes and maintains monetary case reserves to cover medical costs and projected miscellaneous and compensation costs; prepares written requests for settlements; settles litigated cases that do not require a defense attorney and advises as appropriate; reviews cases for subrogation potential and files related actions.
  
• Computes permanent disability case ratings and awards; coordinates benefits with other City benefits; prepares information for submission to the Workers' Compensation Appeals Board, Disability Evaluation Unit, and Administrative Director; files appropriate actions such as answers, declarations, pleadings and objections.
  
• Communicates verbally and in writing with injured employees, their departments, physicians, dependents, attorneys, City safety representatives, Workers' Compensation Appeals Board members, and other interested parties; reviews established claims periodically to prompt action and closure, and/or settlement.
  
• Sets medical evaluations and coordinates return to work, interactive process, utilization review, independent medical review, and independent bill review; attends mandatory settlement conferences, hearings, and meetings relevant to cases.
  
• Provides exceptional customer service to those contacted in the course of work.
  
• Other related duties may also be performed; not all duties listed are necessarily performed by each individual holding this classification.

Knowledge of:

• State of California Workers' Compensation laws, administrative regulations, and claims adjusting procedures.
  
• Principles and practices of permanent disability rating, utilization review program, independent medical review program, independent bill review program, supplemental job displacement benefits program, return to work program and disability management programs.
  
• Principles and practices of reserving and excess carrier reporting.
  
• Medical and legal terminology relating to Workers' Compensation matters.
  
• Oral presentation techniques.

Skill in:

• Evaluate permanent disability.
• Use of computers, computer applications, and software.

Ability to:

• Interpret, explain, and apply Workers' Compensation laws and administrative rules and regulations.
  
• Analyze complex data, including medical reports, and make appropriate decisions.
  
• Make accurate arithmetical computations.
  
• Speak and write effectively.
  
• Establish and maintain effective relationships with injured employees and their families, attorneys, and physicians.

EXPERIENCE AND EDUCATION
Experience:
Three years of Workers' Compensation claims adjusting experience in an insurance company, third-party administrator, or self-insured employer. Public agency experience is desirable.
-AND-
Education:
Possession of an Associate's Degree or 60 semester units or equivalent quarter hours from an accredited college or university with major course work in public or business administration, economics, accounting, human resources, or a related field.
Substitution:
Additional qualifying experience may substitute for the required education on a year for year basis.
- OR -
Possession of certificate proving successful completion of the Self-Insurance Administrator's Examination may substitute for the required education.
PROOF OF EDUCATION
Should education be used to qualify for this position, then proof of education such as, but not limited to, university/college transcripts and degrees should be submitted with your application and will be required at the time of appointment. Unofficial documents and/or copies are acceptable.
An applicant with a college degree obtained outside the United States must have education records evaluated by a credentials evaluation service. Evaluation of education records will be due at time of appointment.
SPECIAL QUALIFICATIONS
Driver License:
Possession of a valid California Class C Driver License at the time of appointment. Individuals who do not meet this requirement due to physical disability will be reviewed on a case-by-case basis.
Certification:
Possession of an Experienced Claims Examiner designation is required at time of appointment, per California Insurance Code Section 11761.
Possession of, or ability to obtain by time of appointment, required post-designation training, pursuant to is required at time of appointment, per California Insurance Code Section 11761 and California Code of Regulations, Title 10, Sections 2592.02, 2592.03, 2592.04, and 2592.05.
PROOF OF CERTIFICATION
Proof of the required certificate and/or license should be submitted with your application and will be required at the time of appointment. Unofficial documents and/or copies are acceptable.
Please note, the City of Sacramento's preferred method of communication with applicants is via e-mail. As such, please ensure you verify the e-mail address on your application, and check your e-mail frequently, including your spam and junk folders. All e-mail notifications can also be accessed through the governmentjobs.com applicant inbox.
1. Application: (Pass/Fail) - All applicants must complete and submit online a City of Sacramento employment application by the final filing deadline;

• Employment applications must be submitted online; paper applications will not be accepted.
• Employment applications will be considered incomplete and will be disqualified:
  • If applicants do not list current and past job-related experience in the duties area of the "Work Experience" section. Note: Qualifying experience is based on full-time experience (40 hours per week). Qualifying experience is calculated to the full-time equivalent (pro-rated if less than 40 hours/week).
  • If "see resume" is noted in the "Work Experience" section; a resume will not substitute for the information required in the "Work Experience" section.
• Position/job titles will not be considered in determining eligibility for meeting the minimum qualifications for this position.
• Proof of education such as, but not limited to, university/college transcripts and degrees should be submitted online with your application. Proof of education will be required at time of appointment.
• Proof of certification and/or license should be submitted online with your application. Proof of certification and/or license will be required at time of appointment.

2. Supplemental Questionnaire: (Pass/Fail) - In addition to the City of Sacramento employment application, all applicants must complete and submit online responses to the supplemental questionnaire to the City of Sacramento Employment Office by the final filing deadline;

• Responses to the supplemental questionnaire must be submitted online; paper questionnaire will not be accepted.
• Incomplete supplemental questionnaire will not pass the review process; omitted information cannot be considered or assumed.
• A resume will not substitute for the information required in the supplemental questionnaire.
• Possession of the minimum qualifications is not necessarily a guarantee for further advancement in the selection process.

3. Screening Committee: (Pass/Fail) - All applications received by the final filing deadline will be forwarded to the hiring department for review. The hiring department will select the most competitive applications for further consideration. Human Resources will only evaluate employment applications for the minimum qualifications, as stated on the job announcement, for applications selected by the hiring department.
4. Interview Process: Human Resources will forward applications to the hiring department. Those determined to be the most qualified candidates will be invited to participate in an interview process.
5. Conditional Hire: Upon receipt of a conditional offer, the selected candidate must complete and pass Live Scan/fingerprinting. If applicable, candidates may also need to pass a pre-employment medical exam, controlled substance and/or alcohol test, and possess any required licensure or certification prior to receiving a start date from the Department. Failure to meet these prerequisites will be grounds for withdrawal of your conditional offer of employment.
QUESTIONS:
For questions concerning this job announcement and the application process:

• Please visit https://www.governmentjobs.com/Home/ApplicationGuide for a comprehensive, step-by-step guide to the application process.
• For technical support between 6 AM - 5 PM PT, contact Live Application Support at 855-524-5627.
• Visit the City of Sacramento Human Resources Department website at https://www.cityofsacramento.gov/HR/employment;
• Send an email to employment@cityofsacramento.org; or
• Call the Human Resources Department at (916) 808-5726

Employment Type: Full-Time Career