Claims Examiner

1 week ago

San Bernardino, California, United States The Ladders Full time
Salary: $ $44.75 Hourly

Location : San Bernardino City Unified School District, CA

Job Type: Most positions work 8 hours/12 months

Job Number:

Department: Business Services Division

Opening Date: 05/01/2024

Closing Date: Continuous

Job Description

DEFINITION

To perform journey-level specialized and complex technical work in support of the District Workers' Compensation claims program; to examine and adjust claims and monitor claims expenditures.

SUPERVISION RECEIVED AND EXERCISED

Receives general supervision from the Workers' Compensation Manager and functional supervision from a Senior Claims Examiner.

Exercises technical and functional supervision over clerical staff and modified-duty workers in the absence of the Workers Compensation Manager.

Examples of Duties

Duties may include, but are not limited to, the following:
  • Reviews, examines, and adjusts Workers' Compensation claims.
  • Receives and records all claims and determines compensability.
  • Authorizes medical treatment and/or changes of physician, utilizing California State Workers' Compensation law.
  • Computes and authorizes payments according to California Labor Code.
  • Sets reserves.
  • Advises employees and dependents of entitlement to Workers' compensation benefits under State law and District policy.
  • Arranges special investigations and medical examinations.
  • 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 cases for litigation and subrogation recovery.
  • Corresponds with doctors and attorneys.
  • Attends Workers' Compensation Appeals Board hearings and authorizes settlements as directed by the Workers' Compensation Manager.
  • Serves as custodian of records; produces records and attests to validity under the direction of the court by subpoena.
  • Develops documentation for claims reports by requesting substantiating reports from physicians, supervisors, and witnesses.
  • Compiles pertinent facts, makes thorough analysis, and arrives at sound decisions.
  • May at times oversee work activities of clerical staff and give input on their performance evaluations.
  • Travels to sites where presence is required, using personal transportation.
  • Performs related duties as assigned.
Qualifications

Experience and Education/Training
Any combination of experience and education/training that demonstrates an ability to perform the essential functions of the job. (These ar the minimum experience and education/training standards which will be used to admit or reject applicants for examination, as approved on the date below.)

Two years of Workers' Compensation claims processing experience.
AND
Sixty semester units of college course work supplemented by specialized training or courses in Workers' Compensation laws, claims adjusting, disability ratings, rehabilitation or closely related fields.

(Substitution: Additional experience of the kind indicated in excess of the required two years may be substituted for the required education on the basis of three months of additional experience for five semester units of college course work. NOTE: High school graduation or the equivalent is required of every applicant.)

Licenses/Certificates/Registrations
An appropriate, valid California driver's license and auto liability insurance.*
A California State Certificate to Administer Claims for Self-Insured Employers.**
Additional Information

CLICK HERE TO VIEW THE COMPLETE JOB DESCRIPTION.

DISTINGUISHING CHARACTERISTICS: Differs from Workers' Compensation Clerk in that Claims Examiner performs journey-level Workers' Compensation claims adjustment work while Workers' Compensation Clerk performs specialized clerical duties in support of the District Workers' Compensation program.

LICENSES/CERTIFICATES/REGISTRATIONS:An appropriate, valid California driver's license and auto liability insurance.* A California State Certificate to Administer Claims for Self-Insured Employers.**

SPECIAL REQUIREMENT: Personal transportation for travel to locations where District business requires attendance. *Must be submitted upon offer of employment and maintained throughout employment in this position **Must be submitted within two years of employment in this classification.

RECRUITMENT TYPE: OPEN & PROMOTIONAL (Anyone may apply for this position).

APPLICATIONS: Following closing of recruitment, no additional application material or information will be accepted.

ADDITIONAL SALARY INFORMATION: This is a non-exempt position, Regular Classified Salary Range 46A. Positions in this class work 8 hours 12 months. The probationary period for employees in this classification is six (6) months (or 130 working days of paid service).
BENEFITS: Health, Vision, Dental and PERS (retirement). Benefits are available to full-time and part-time employees.
For complete details visit

THE EXAMINATION: Qualified applicants will be notified of the time and place of the examination.
Training and Experience Evaluation. WEIGHT: 100%
Applicants must achieve a passing score in each part of the examination process in order to be placed on the eligibility list.
Note:
The proposed examination parts may be changed at any time following close of recruitment. Candidates will be notified in accordance with Personnel Commission Rules.
Only online applications are accepted via
Computer access is available in the Personnel Commission Office. This eligibility list will be active for a period of one (1) year.

REASONABLE ACCOMMODATIONS:
The Personnel Commission will make every effort possible to ensure that all applicants compete on an equal level. At any time in the employment process, applicants with disabilities may request reasonable accommodations if required. To give district staff adequate time to evaluate each case, and to arrange for accommodations, applicants must submit their request to the Affirmative Action Office at ([redacted] as soon as possible. Failure to do so may result in the inability to provide the necessary reasonable accommodations in a timely manner.

Fingerprinting, drug and tuberculosis testing is required of all successful candidates new to the district.

District employees and external applicants must submit the required proof of education and/or training with each application by uploading copies of a high school diploma, GED certification (or equivalent), transcripts (official or unofficial), college degree(s), and/or training certificates. If the required proof of education is not attached to the application you may be disqualified. All relevant experience must be clearly indicated in the "Work Experience" section of the application. Resumes will not be considered.

Closing Date: Continuous-subject to close any time.

CLASSIFIED NON-MANAGEMENT EMPLOYEE:
PERS Retirement; Medical, Dental, Vision, and Life Insurance; Vacation, Holidays and Sick Leave. Benefits are available to full-time and part-time employees.

CLASSIFIED MANAGEMENT EMPLOYEE:
PERS Retirement; Medical, Dental, Vision, and Life Insurance. Benefits are based on a 40-hour workweek, 8 hours per day.

SCHOOL POLICE OFFICERS:
PERS Retirement; Medical, Dental, Vision, and Life Insurance. Benefits are based on a 40-hour workweek.
School Police Officers Differential compensation:
POST Intermediate Certification: 6% to base pay
POST Advanced Certification: 8% to base pay
Associate degree: 5% to base pay
Bachelor degree: 7% to base pay
Master degree: 9% increase to base pay

For complete benefit details, please visit

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