Claims Examiner

• Investigate workers’ compensation claims; interview and take statements from City employees and witnesses; authorize and/or schedule appropriate medical care; refer to and continue to monitor Utilization Review pursuant to the California Labor Code, keeping within the time constraints outlined to avoid penalties.
  
  
• Review and evaluate injury reports submitted by departments; interpret all aspects of State workers’ compensation law; evaluate, determine, and authorize payment of all workers’ compensation benefits.
   
• Inform employees injured on the job of their rights and benefits under workers’ compensation.
  
  
• Conduct and monitor workers’ compensation investigations; obtain and review past and present medical records of injured parties; assign investigations to outside agencies and monitor their performance; review written or recorded statements.
  
  
• Identify, review, and investigate subrogation claims to ensure monies due the City are collected; monitor each case for Statue of Limitations and coordinate workers’ compensation subrogation recoveries with City Attorney’s Office; issue Notice of Offer of Return to Regular Work, Notice of Offer of Modified Duty, and Notice of Potential Right to Supplemental Job Displacement Benefits within proper time frame.
  
  
• Assist in the defense of City cases; prepare necessary legal documents and represent the City at legal proceedings and conferences; negotiate with claimants and claimants' attorneys for settlements; determine recovery potential.
  
  
• Review and evaluate loss and accident reports to identify potential hazards; coordinate with the Safety Manager in identifying employee safety exposures and necessary loss prevention measures.
  
  
• Establish claim reserves based on judgment and experience; monitor benefit payments on individual claims and implement cost containment procedures.
  
  
• Coordinate workers’ compensation training for supervisory and management staff of all departments; stay current on federal, state, and local laws, codes, and regulations related to workers’ compensation.
  
  
• Perform related duties as required.

• Four years of responsible senior level claims analysis/administration experience supplemented by a Bachelor’s degree from an accredited college or university with major course work in risk management, claim adjustment, business administration, public administration, or a related field. An equivalent combination of experience and education sufficient to perform the essential job functions and provide the required knowledge and abilities is qualifying.
  
  
• Candidates must demonstrate knowledge of principles of negotiation and claim settlement procedures and techniques; familiarity with  legal proceedings; claims processing and administration principles and practices; principles of reserving; principles and procedures of estimating property damage is required for some positions; basic medical terminology; principles, practices, and procedures of claims control; statutory benefits is required for some positions; principles and practices of various insurance policies; memorandums of understanding for bargaining units is required for some positions; City policy on permanent light duty, modified work, and industrial disability retirement programs is required for some positions; principles and practices of accident prevention and investigation; principles of business letter writing; principles and procedures of record keeping; customer service and public relations methods and techniques; office procedures, methods, and equipment including computers and applicable software applications such as word processing, spreadsheets, and databases; pertinent federal, state and local laws, codes and regulations.
  
  
• Ability to perform a full range of technical, administrative, and programmatic work of a general or specialized nature involving the use of independent judgment and personal initiative in support of assigned Risk Management function; organize and review the work of technical and clerical personnel; assist in the supervision, training and evaluating of staff; plan, organize and supervise the preparation of confidential documents; gather, research, analyze, organize, and disseminate data essential to the collection of funds due the City; interpret and explain City workers’ compensation or general liability policies and procedures; interpret applicable statutes and case law; review and interpret medical reports and determine extent of disability or injury; identify cases with third party potential; prepare files for litigation and negotiation; coordinate in house rehabilitation plans is required for some positions; implement and maintain filing systems; work under steady pressure with frequent interruptions and a high degree of public contact by phone or in person; plan and organize work to meet changing priorities and deadlines; operate office equipment including computers and supporting word processing, spreadsheet, and database applications; work independently in the absence of supervision; understand and follow oral and written instructions; communicate clearly and concisely, both orally and in writing; and establish and maintain effective working relationships with those contacted in the course of work.
  
  
• Possession of, or ability to obtain within one (1) year of appointment, Self-Insurance Administrator (SIA) Certification, issued by the State of California, Department of Industrial Relations.  Possession of, or ability to obtain within one (1) year of appointment, a Workers' Compensation Claims Professional (WCCP) Certification.
  
  
• Meets the requisite experience requirements as set forth in the regulations (Section 2592.01(f)). Subsequent to the initial designation, Claims Examiner shall receive a Post-Designation Training Form that demonstrates he or she has met the required 30 hours of post-designation training every two years.
  
  
• Must possess a valid, appropriate driver's license.

IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received.  The deadline for the first review of applications is on Friday, March 29, 2024 at 5:00PM.  Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment.  This recruitment may close at any time without notice after the first review date.

Qualified applicants may be invited to a written exam.  Successful applicants will be invited for an oral interview.

Candidates must be specific and complete in describing their qualifications for this position. Failure to state all pertinent information may lead to elimination from consideration.  Stating "See Resume" is not an acceptable substitute for a complete application.

The successful candidate will be required to undergo a reference / background check (to include a conviction record) and pass a post-offer pre-employment medical examination (which will include a drug/alcohol screening).  The City of Anaheim utilizes E-Verify and new employees must provide documentation to establish both identity and work authorization.

Communications regarding your application and/or status will be sent to the email address listed on your application.  Please check your email regularly throughout the recruitment process as you will not receive communication by any other method.