Workers' Compensation Claims Adjuster III
County of Santa Clara
- San Jose, CA
- $103,813-126,231 per year
- Permanent
- Full-time
- Trains, reviews and evaluates the work of lower levels of Workers' Compensation Claims Adjusters;
- Serves as subject matter expert on the more complex Workers' Compensation Claims;
- Adjusts on-the-job injury claims for County employees and determines compensability and reserve requirements;
- Conducts interviews with claimants, witnesses, supervisors and physicians regarding claims to ascertain the creditability of the claims;
- Identifies need for modified or alternate work accommodations or retraining services;
- Requests and records substantiating documentation from physicians, departments and witnesses;
- May prepare the litigation file, develop the case and negotiate Compromise and Release agreements or stipulations and/or assists counsel in these functions;
- May represent the County before the Workers' Compensation Appeals Board;
- Makes provisions for medical treatment, payment of medical bills and all compensation benefits;
- Manages and controls caseload through periodic review of all open cases and determines course of action including case closures;
- Initiates investigation of accidents or injury causes and the status of disabled employees in order to determine facts and evidence to support the satisfactory disposition of cases;
- Prepares reports and correspondence;
- Performs related work as required.
ORB. Completion of at least 160 hours of workers' compensation training, of which at least 120 hours shall be conducted in a classroom with an instructor, completed within a 12 month period.
ORC. Have worked five (5) years in the last eight (8) years of on-the-job experience adjusting California workers' compensation claims, or supervising claims adjusters handling workers' compensation claims.3. Possession of a valid California driver's license prior to appointment and the ability to qualify for and maintain a County Driver's Permit.Ongoing Special Requirement:Workers' Compensation Claims Adjusters III are required to complete Post Designation Training of thirty (30) hours every two (2) years.Knowledge of:
- Workers' compensation principles and policies;
- Provisions of the Workers' Compensation Laws of California;
- Practices and procedures of the Workers' Compensation Appeals Board;
- Medical and legal terminology;
- Current trends in decisions of the courts and Workers' Compensation Appeals Board on compensation cases;
- The effective use of the Schedule for Rating Permanent Disabilities;
- Resources available for providing modified or alternate work accommodations or retraining of the injured or disabled;
- Common office computer applications such as word processing, spreadsheet and databases;
- Office practices and procedures.
- Exercise good judgment in interpreting and applying the provisions of the Workers' Compensation Laws;
- Collect and analyze legal and medical evidence and draw sound conclusions;
- Establish and maintain cooperative and effective working relationships with those contacted in the course of work;
- Oversee the day-to-day operations of a work unit;
- Speak and write effectively.
The County offers robust retirement plans including a (similar to the private sector's 401(k) plan) and the . In addition to lifetime retirement income available through the CalPERS pension plan, the 457(b) Deferred Compensation plan provides a great way to save for retirement and supplement the defined benefit pension available to employees. These plans help our employees build a plan for their future and contribute to their family's long-term financial well-being.Health Flexible Spending Account
The empowers employees to manage healthcare expenses efficiently with tax-free contributions (up to $3,200 for the 2024 calendar year). Secure tax-free solutions for your healthcare expenses and enjoy the flexibility to manage your healthcare finances effectively with the HFSA.Dependent Care Assistance Program (DCAP)
The enables employees to utilize tax-free funds for dependent care services, facilitating a convenient and cost-effective approach for managing your dependent care expenses. The County also offers the , an employer-funded DCAP, for employees with annual income under $120,000.Life and AD&D
The County offers life and disability benefits including , Insurance, . These benefits ensure financial security and income support when you and your family need it most.Employee Assistance Program (EAP)
The County prioritizes employee mental health and well-being and offers a top-tier through Concern providing confidential counseling sessions covering stress, anxiety, relationships, grief, as well as financial/legal services, personal coaching, child and elder care referrals, and comprehensive crisis support.Employee Wellness
The offers free wellness programing, fitness classes and resources; including Elevate My Wellness an all-in-one platform designed to elevate your well-being journey.Education Reimbursement
A generous program is available, including Education Reimbursement for employees seeking additional training and professional development.NOTE: Benefit and Retirement information may vary from bargaining unit to bargaining unit. Due to changes in State Law, current pension provisions described in the union contracts are not automatically applied. Specific pension benefits for new hires who start on or after January 1, 2013 may be different than indicated in the union contracts.