Workers' Compensation Claims Examiner (U...
City of Santa Ana - Santa Ana, CA

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Under general supervision, performs a variety of duties and responsibilities involving the investigation, evaluation and benefit provisions for workers' compensation claims.

Essential Functions Include But Are Not Limited To:
Reviews, evaluates and investigates reported claims to determine compensability and appropriate provisions of workers' compensation benefits. Communicates with and coordinates claims and related activities with claimants, witnesses, physicians, attorneys, inter-departmental contacts and state agencies as appropriate. Within specified authority levels, establishes reserves for claims exposures and ensures that changes in claims reserve levels are documented and accurate. Monitors claim progress and medical care, reviews a variety of claim file documents, identifies issues and ensures adherence to statutory requirements in processing claims. May be required to attend WCAB conferences and negotiate settlements. Utilizes specialized software to maintain and document all file activities in an accurate and timely manner. Performs other functions as assigned.

Characteristics of successful performers:
The successful Workers' Compensation Claims Examiner is well-organized, detail-oriented, and comfortable working independently or as part of a team dealing with confidential matters. He or she is effective in communicating with a variety of individuals, is sensitive to their needs and balances those needs with the best interests of the city.

Minimum Qualifications:
One year of experience examining claims and completion of two or more IEA courses in workers compensation, preferably supplemented by two years of college work with specialization in pre-law, nursing , accounting or related field or any equivalent combination of experience and training resulting in the knowledge, skills and abilities listed below. Desirable knowledge, skills and abilities: Knowledge of : California workers' compensation rules, regulations and fundamental case law; basic medical terminology, diagnoses and procedures; benefit rates and calculations; permanent disability rating schedule. Ability to : Conduct research and analyze information; respond to claim inquiries; negotiate issues and settlements; organize and review a variety of claim file documents; identify issues and process claims in a timely fashion within the limits of the laws; communicate effectively both orally and in writing.
Skill in : The use of personal computers and standard business software, preferably including Microsoft Office applications in a windows environment; use of calculators and typical office equipment.

Selection Process:
All applicants are required to complete and submit a City application form online. Resumes or faxed copies will not be accepted in lieu of an application. To apply, click on the "Apply" link located at the top of this page. New users must create an account first. Click on this link for instructions on how to set up your account and apply for the first time: Online Employment Application Guide .

Application Review : Applications will be reviewed by the Personnel Services Department. Applicants possessing the most pertinent training and experience will be invited to continue in the selection process.

Oral Interview Examination : (Weight of 100%) will evaluate the candidates' experience, education, training and abilities in relation to those factors which are essential for successful performance on the job. Candidates need a minimum passing score (70%) in order to be placed on the eligible list.

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