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The County of Riverside Human Resources Department is seeking a Claims Adjuster I/II to support the Workers' Compensation Division. The level at which the position will be filled is at the

Department's discretion and is based on candidate qualifications. This position will carry a caseload of workers' compensation claims and will be responsible for establishing contact with injured workers, conducting Arising Out of Employment (AOE) and Course of Employment (COE) investigations, and determining if the injuries or illnesses are compensable. The Claims Adjuster II will also review claims for subrogation, prepare settlement documents, and calculate and approve benefit payments. A California Self Insured Certificate is required for this position.   

Positions in this class series report to the Workers' Compensation Officer and are characterized by responsibility to perform claims casework for the County's various self-insurance programs including general liability, medical malpractice and workers' compensation claims. Incumbents, within delegated settlement authority, bring such cases to resolution by recommending the acceptance or denial of claims and to adjust cases involving the County's various self-insured programs from the initial report to final resolution.

MINIMUM QUALIFICATIONS

Claims Adjuster I

$26.63 - $38.03 Hourly

$55,392.48 - $79,092.42 Annually 

Certificate Required: A California Self Insured Certificate is required at the time of application. 

Experience: Considerable journey-level experience reviewing and processing Workers' Compensation, on-the-job injuries, job-related illnesses, physical disability, personal injury, medical malpractice or property damage liability claims including investigating, adjusting and settling a wide variety of claims. For employees assigned to the Workers' Compensation Unit, must have achieved the level of Designated Claims Adjuster (as defined by California Code of Regulations, Title 10, Chapter 5, Subchapter 3). Possession of an IEA Certificate with a satisfactory passing grade is required within two years of appointment.   

Claims Adjuster II

$34.35 - $45.31 Hourly

$71,439.47 - $94,240.22 Annually 

Certificate Required: A California Self Insured Certificate is required at the time of application.   

Experience: Extensive journey-level experience reviewing and processing Workers' Compensation, on-the-job injuries, job-related illnesses, physical disability, personal injury, medical malpractice or property damage liability claims including investigating, identification and investigation of fraud cases, adjusting and settling a wide variety of claims. For employees assigned to the Workers' Compensation Unit, candidates must have achieved the level of Experienced Claims Adjuster (as defined by California Code of Regulations, Title 10, Chapter 5, Subchapter 3) defined as possessing one of the following: 1) Working 5 out of the last 8 years as a California Worker's Comp Claims Adjuster, 2) Has worked continuously in California adjusting claims since passing the Self-Insurance Test, or 3) Has passed the Self-Insurance test in the last 2 years. 

All Levels

Knowledge of: State of California Labor Code, Workers' Compensation Law and rules and regulations (Title 8); Applicable case law of leading decisions of the Workers' Compensation Appeals Board, Court of Appeals, and Supreme Court regarding workers' compensation cases; Medical terminology, anatomy and technical terminology used in medical and legal fields regarding industrial cases; Jurisdiction, functions and procedures of the Workers' Compensation Appeals Board; Vocational rehabilitation and procedures as it applies to Workers' Compensation; Reserving practices and procedures; in-house litigation procedures; WCAB procedures; and hearing processes.

Knowledge of: Practices, techniques and methodologies used in claims investigation, evaluation, adjustment and settlement; Basic rules, regulations, and laws regarding personal and property liability; Principles and techniques of analytical data collection; Principles of insurance reserving, risk and experience analysis and statistical record keeping; Basic mathematics including valuation and depreciation; Computer applications programs and equipment to effectively gather, maintain and report claims data.

Ability to: Communicate, orally and in writing, effectively with a wide variety of people contacted in the course of work; Interpret and apply complex rules, regulations and memoranda of understanding; Establish and maintain cooperative and effective relationships with a broad range of professional staff including attorneys and related legal staff, department heads and managers and all those contacted during the course of performing professional responsibilities; Collect, interpret and evaluate data, develop alternatives and make appropriate recommendations within established guidelines; analyze problems and take effective courses of action; Interpret laws, regulations, and insurance policies; Make accurate mathematical computations; Prepare and present effective written and oral reports and presentations; Maintain professional credibility.

SUPPLEMENTAL INFORMATION

Hybrid Telework  and flexible schedule option after initial training has been completed successfully.