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Under general direction, the Worker's Compensation Supervisor assists and provides first-line oversight of claims adjusting and processing teams for the Workers' Compensation Division. Performs complex work in supervising the review, analysis, investigation and disposition of workers' compensation claims and reports. Provides claims supervision of confidential complex cases; provides technical training, auditing, and supervising of personnel; serves as the departmental liaison to client departments regarding activities of the assigned workers' compensation program; works with the City Attorney's office on litigation strategies; and performs other related duties as required.
Job Responsibility:
Receives and reviews all incoming workers' compensation claims to determine complexity and assign to appropriate claims adjusting staff
Advises claims adjuster, claims assistants, and support staff on appropriate claims handling techniques
Provides claims supervision of catastrophic cases, death cases, and confidential complex cases
Serves as the liaison for the workers' compensation coordinators of the client departments
Serves as the workers' compensation technical expert to advise staff and client departments on changes and applicability of workers' compensation laws
Audits the work product of claims adjusters to ensure compliance with applicable laws, and departmental best practices
Generates statistical reports and completes analysis of data
Works with the City Attorney's office on litigation strategies for complex claims
Reviews all self-imposed penalties to determine liability and authorizes payment
Authorizes medical treatment for complex medical cases
Reviews the assignment of Medical Legal Evaluators (which include Agreed, Qualified, and/or Independent Medical Evaluators) on complex cases
Works collaboratively with the Occupational Nurse Consultant, Nurse Manager, and/or Nurse Case Managers to review complex claims and establish medical protocols
Advises the Occupational Nurse Manager and/or Consultant on issues related to medical clinic operations
Provides ongoing system support to claims staff
Accurately estimates the potential claim costs (reserves) on complex cases
Provides technical assistance to claims adjusters in determining permanent disability award calculations
Directs the claims investigation on complex claims
Reviews and approves negotiated case settlement/s with injured workers, attorneys, and interested parties based on established authority levels
Provides daily supervision, guidance, coaching, and mentoring to assigned staff
Completes ongoing performance evaluations of all assigned staff
Provides specialized technical training, as needed, to staff
Performs related duties and responsibilities as assigned
Requirements:
Four (4) years of verifiable experience adjusting workers' compensation claims
Possession of a Self-Insured Administrator's Certificate issued by the State of California, Department of Industrial Relations
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