Claims Adjuster jobs in Riverside, CA

• Workers' Compensation Claims: Reviews, investigates and processes reports and claims concerning on-the-job injuries or job-related illness of County employees for claims filed against the County and determines if the illness or injury is compensable; arranges disability evaluation appointment and maintains medical control; responds to inquiries from excess insurance carriers, doctors, and legal professionals.

• Prepares cases for legal defense; assists in the preparation of appeals cases before the Workers' Compensation Appeals Board; secures documentary evidence of births, deaths, marriages and divorces in fatality cases.

• Evaluates advisory and informal ratings as a basis for claims settlement; rates permanent disabilities pursuant to California Rating Schedule; approves payment for medical services, temporary disability and permanent disability awards subject to delegated authority as determined by the Risk Management Division Manager.

• Prepares subrogation recovery cases; analyzes investigative and police reports; arranges special investigations and medical examinations.

• Develops, maintains, and analyzes statistical data on claims expenditure trends and provides appropriate report and recommendations; stays abreast of current Workers' Compensation and civil claims litigation.

• Senior Workers' Compensation Claims: Assigns and reviews the work of Adjusters and Technicians; trains and provides technical assistance to new and journey-level Adjustors.

• Examines and adjusts third party claims, via contract, for County Departments with special programs.

• Coordinates the County's defense appeal for safety disability retirement denials and makes presentation before the retirement appeals board.

• Assists the Workers' Compensation Officer with the implementation of special programs such as in-house litigation; determines which claims for adjudication will be litigated by in-house staff.

• Assists in the supervision and maintenance of statistical and budget records and participates in studies of industrial accident matters.

• Gathers and reviews data, reports and other claim documentation; requests clarifying or additional information; reviews status and performs necessary follow up.

• Conducts investigations to determine circumstances involved in claims against the County; including interviewing witnesses and inspecting the scene of accidents, injuries or property damage; prepares investigative report of findings.

• Conducts interviews with parties responsible for damage to County property and injuries to County employees to ensure collection of payments; contacts public and private organizations/agencies to obtain collections information; recommends actions necessary to enforce collections including court actions or liens.

• Represents the County in small claims actions.

• Prepare reports of costs and status on active and closed claims.

• May authorize subrogation, court actions or liens when collections can not be obtained by other means; reviews and makes recommendations for suspension, modification, garnishment or other legal actions; corresponds with attorneys, insurance carriers and others; interprets legal procedures involved in the collection or subrogation accounts.

• Consults with attorneys to prepare cases for litigation.

• Serves as custodian of records; provides subpoenaed records and attests to their validity.

• May assign and review the work of others and provide training to new employees.

• Assists the program supervisor to develop and maintain claims records and computer record keeping systems; assures accuracy conformance to policies and procedures and accessibility of claims records.

• Assists attorneys in the preparation of complex case for litigation ensuring the availability and accuracy of all necessary documentation.

• Assigns and reviews the work of Adjusters and Technicians; trains and provides technical assistance to new and journey-level Adjustors.

License: A valid California Driver's License is required at the time of appointment or the ability to arrange transportation for field travel.

The incumbent may be required to use a personal vehicle and provide verification of auto insurance coverage as required by the County of Riverside.