Workers' Comp Senior Claims Examiner and Systems Administrative Assistant

Redwood Empire Schools' Insurance Group   Windsor, CA   Full-time     Administration / Clerical
Posted on November 6, 2021
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These are 2 Separate Positions:

Workers’ Compensation Senior Claims Examiner

Annual Salary:

Salary Range: $81,829 – $104,437

Starting Salary:

COMMENSURATE WITH QUALIFICATIONS & EXPERIENCE

Terms:

Full-Time – 12 Month Position

Subject to a one-year probationary period

Benefits:
Mandatory Participation For Medical Benefits.
Employee/dependent medical (80% Employer/20% Employee); employer-paid dental, vision, life insurance, short term/long term disability; employee/employer-paid retirement (CalPERS); vacation and sick leave.

(RESIG does not pay into Social Security or SDI—State Disability).

Definition:

This is an advanced Claims Examiner position. Under the general supervision of the Workers’ Compensation Manager and Claims Supervisor, this position is responsible for the investigation, evaluation, and settlement of claims.

Principal Job Duties

  • In accordance with claims management procedures, review, investigate, and manage workers’ compensation claims for member school districts with use of a computerized claims management system.
  • Obtain all documentation to substantiate the facts surrounding a claim.
  • Evaluate and analyze the extent of exposure to accurately reserve claims.
  • Analyze, make recommendations, and approve medical treatment plans from treating physicians and providers.
  • Administer claim settlement authority according to policy.
  • Administer statutory benefits to injured workers.
  • Identify and pursue potential subrogation.
  • Identify excess insurance claims, prepare reports to excess insurance carriers, and process reimbursements.
  • Prepare concise reports for attorneys, physicians, member districts, and management.
  • Provide status update to management on complex and/or sensitive claims.
  • Develop and conduct periodic file reviews with member districts.
  • Prepare claims for defense, settlement, subrogation, or arbitration activity.
  • Provide direction to defense counsel, investigators, and vendors. Monitor and control claims costs.
  • Delegate non-essential and/or clerical work to Claims Assistants and clerical support staff.
  • Represent RESIG in hearings, settlement conferences, and trials.
  • Develop and implement strategy to manage claims to an accurate and timely conclusion.
  • Provide backup to Claims Examiners in their absence.
  • Set and/or adjust schedule as needed for meetings, trainings, conferences, and work­related events.
  • Performs other duties as assigned.

Knowledge and Skills

  • Workers’ Compensation claim adjusting, investigation, and administrative techniques necessary to manage claims from initial report of injury to settlement or closure.
  • California Labor Code, Government Code, and Education Code sections relative to workers’ compensation benefits.
  • Reserving practices and techniques in accordance with laws sufficient to establish and maintain adequate financial levels on all claims, with understanding of excess carrier reporting.
  • Office methods and equipment, audio visual equipment, filing systems, telephone techniques, letter and report writing, and well-developed computer skills required in Windows-based applications.
  • Computer skills sufficient to manage workers’ compensation claims using an internal data processing system, including imaging system.

Ability to

  • Organize, develop, and prepare claims for assignment to counsel, trial, and mandatory settlement conferences.
  • Learn, interpret, and apply specific rules, laws, and policies necessary to apply them with good judgement in the administration of public entity claims.
  • Establish and maintain cooperative relationships with peers, managers, and those contacted in the course of work.
  • Analyze claim developments and adopt effective courses of action necessary to close claims.
  • Work independently and/or collaborate with RESIG management.
  • Represent RESIG in a manner consistent with the policies, practices, and procedures of the organization.
  • Attend conferences, off-site trainings, seminars, and other work-related events.
  • Communicate effectively, both verbally and in writing.
  • Independently and effectively organize and prioritize workload with frequent interruptions.
  • Obtain and maintain CA Self-Insurance Administrator’s Certificate within the first year of assuming the Workers’ Compensation Senior Claims Examiner position.

Working Conditions

  • Frequently travel to various schools, vendors, meeting sites, and conferences.
  • Must provide means of transportation.
  • Must provide proof of a valid California driver’s license and California vehicle insurance.
  • Work with office equipment, audio visual equipment and computerized workstation which involves repetitive arm and hand movement.
  • Work while sitting, standing, bending, stooping, squatting, kneeling, and climbing.
  • Lift and carry up to 25 pounds.
  • Travel to various schools, vendors, meeting sites, and conferences.

Experience and Education

  • A minimum of 3 years experience of increasingly complex w/c claims adjusting/examining and currently performing work at Senior Claims Examiner level.
  • A California Self-Insured Administrator’s Certificate is preferred.
  • High School Diploma or equivalent required; college degree preferred.
  • Experience with the public sector or public schools is desirable.

Workers’ Compensation Systems Administrative Assistant

Rate Per Hour:

$26.88 – $34.31

COMMENSURATE WITH QUALIFICATIONS & EXPERIENCE

Terms:

Full-Time

Subject to a one-year probationary period

Benefits:
Mandatory Participation For Medical Benefits.
Employee/dependent medical (80% Employer/20% Employee); employer-paid dental, vision, life insurance, short term/long term disability; employee/employer-paid retirement (CalPERS); vacation and sick leave.

(RESIG does not pay into Social Security or SDI—State Disability).

Definition:

Under the direct supervision of the Workers’ Compensation Claims Manager, the Claim Systems Administrative Assistant is responsible for basic maintenance of the Claims Risk Management Information System (RMIS) and will provide clerical assistance and support related to the Workers’ Compensation Claims Department. Will work with RMIS vendors and staff on system changes, basic programming, updates, maintain data and prepare a variety of reports in an accurate and timely manner. Assist with implementation of technology-related projects. Will perform a variety of general clerical duties of average difficulty, using a personal computer and other routine office equipment. This position will also be expected to perform related work as assigned and required.

Principal Job Duties

  • Perform basic system maintenance tasks on the Risk Management Information System (RMIS) as directed or required, including updates and upgrades.
  • Inform users about system updates, upgrades, downtime, or other issues impacting system performance or access.
  • Generate reports from the RMIS or related systems for such purposes as loss trending or evaluating claim outcomes.
  • Troubleshoot data related anomalies to ascertain source and resolve with vendors and/or staff.
  • Provide accurate and timely reports to state agencies, excess insurers, and other data recipients.
  • Help develop and maintain forms and procedures related to system administration and maintenance.
  • Sort and direct mail.
  • Scan and link mail, reports, and documents into the RMIS.
  • Perform various computer functions including maintenance of databases, processing of bills for transmission, typing of routine documents and correspondence, electronic file transfers, check printing/processing, and Medicare queries.
  • Maintain hard-copy and electronic files and records, as necessary.
  • Communicate with school districts, vendors, injured workers, etc., via telephone, e-mail and in-person.
  • Provide back up to the front-desk Clerical/Receptionist and Resource Coordinator, as needed.
  • Research a variety of topics using the Internet or other sources.
  • Copy materials and prepare informational packets.
  • Set and/or adjust schedule, as needed, for meetings, trainings, conferences, and other workrelated events.
  • Assist with projects as assigned.
  • Performs other duties as assigned.

Knowledge and Skills

  • Well-developed skills in Microsoft Office Suite, including Word, Excel, Outlook, and Online Meeting Platforms.
  • Office methods and equipment, audio visual equipment, filing systems, telephone techniques, letter writing, and well-developed computer skills required in Windows-based applications.
  • Basic mathematical principles
  • Principles and practices of report preparation
  • Operations, services, and activities of claims management system (i.e., RMIS)
  • Recordkeeping techniques

Ability to

  • Learn, interpret, and apply specific rules, laws, and policies necessary to apply them with good judgement in the administration of public entity claims.
  • Learn basic computer programming
  • Organize and prioritize multiple projects and complete them on time.
  • Review and interpret data transactions and records, to ensure accurate data.
  • Independently and effectively organize and prioritize workload with frequent interruptions.
  • Create and maintain accurate spreadsheets and files.
  • Enter and retrieve data from computer systems.
  • Prepare clear and concise written and verbal reports.
  • Understand and carry out oral and written instructions.
  • Adapt to changing situations, analyze situations accurately and adopt an effective course of action.
  • Collaborate effectively with others to complete projects and resolve issues.
  • Establish and maintain cooperative relationships with those contacted in the course of work.
  • Attend conferences, off-site trainings, seminars, and other work-related events.
  • Read and understand technical manuals.
  • Typing/computer skills sufficient to perform the job with a minimum typing speed of 50 wpm.
  • Represent RESIG in a manner consistent with the policies, practices, and procedures of the organization.
  • Observe health and safety regulations.

Working Conditions

  • Lift and carry up to 25 lbs. on a regular basis and up to 45 pounds on an occasional basis.
  • Work and walk on slippery, uneven, or irregular surfaces.
  • Work while sitting, standing, bending, stooping, squatting, kneeling, and climbing.
  • Work with office equipment and computerized workstation which involves repetitive arm and hand movement.
  • Travel to various schools, vendors, meeting sites, and conferences.
  • Extensive employee contact and frequent interruptions.
  • Vision sufficient to read small print, computer screens and other printed documents.

Experience and Education

  • Minimum of three (3) years clerical experience.
  • High school diploma or equivalent required.
  • Coursework or experience with XML, Java, SQL, HTML, and/or related programming is preferred.
  • Experience with the public sector or public schools is desirable.