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County of Riverside · 1 day ago

Temporary Senior Claims Adjuster

Riverside County, CA

Full-time

Hybrid

Senior Level

5+ years exp

The County of Riverside is seeking a Temporary Senior Claims Adjuster to join their Human Resources Temporary Assignment Program. This role involves managing claims, conducting investigations, and ensuring communication with stakeholders while maintaining data integrity and supporting legal processes.

GovernmentHealth CarePublic RelationsPublic SafetySocial

No H1B

Responsibilities

Process and manage indemnity and expense payments

Conduct investigations on existing claim inventories

Review and maintain file reserves to ensure accuracy and adequacy

Review, sort, and document incoming mail

Return voicemails and maintain timely communication with stakeholders

Draft and send instructions to the Clerk of the Board regarding rejection letters

Assist with Medical Malpractice verification processes

Request and obtain police reports

Prepare and send subrogation letters

Summarize and analyze liability information in claim files

Assist in gathering documentation from stakeholders for legal defense

Perform data entry to maintain file integrity

Obtain signatures for notarization related to collections

Make contact calls as needed to support case progress

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

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

Receives, reviews, accepts or denies public liability claims including malpractice, property and personal claims; evaluates medical reports and reports of experts to determine extent of liability and damages; evaluates merit of claims and recommends settlement or denial of claims; estimates anticipated settlement value makes adjustments and settles claims within assigned monetary authority

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 prepare and present training program educating staff about the Liability Claims Program

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

Investigates difficult and complex public liability claims and those involving a greater degree of sensitivity and/or complexity

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

Assists the Liability Claims Program Supervisor with the implementation of special programs; assists in the supervision and maintenance of statistical and budget records and participates in studies

Qualification

Workers' Compensation LawClaims InvestigationLiability Claims ManagementData AnalysisSubrogation RecoveryMathematical ComputationCommunication SkillsTeam LeadershipProblem Solving

Required

Knowledge of practices, techniques and methodologies used in claims investigation, evaluation, adjustment and settlement

Knowledge of basic rules, regulations, and laws regarding personal and property liability

Knowledge of principles and techniques of analytical data collection

Knowledge of principles of insurance reserving, risk and experience analysis and statistical record keeping

Knowledge of basic mathematics including valuation and depreciation

Knowledge of 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

Ability to interpret and apply complex rules, regulations and memoranda of understanding

Ability to establish and maintain cooperative and effective relationships with a broad range of professional staff including attorneys and related legal staff, department heads and managers

Ability to collect, interpret and evaluate data, develop alternatives and make appropriate recommendations within established guidelines

Ability to analyze problems and take effective courses of action

Ability to interpret laws, regulations, and insurance policies

Ability to make accurate mathematical computations

Ability to prepare and present effective written and oral reports and presentations

Ability to maintain professional credibility

Knowledge of State of California Labor Code, Workers' Compensation Law and rules and regulations (Title 8)

Knowledge of applicable case law of leading decisions of the Workers' Compensation Appeals Board, Court of Appeals, and Supreme Court regarding workers' compensation cases

Knowledge of medical terminology, anatomy and technical terminology used in medical and legal fields regarding industrial cases

Knowledge of jurisdiction, functions and procedures of the Workers' Compensation Appeals Board

Knowledge of vocational rehabilitation and procedures as it applies to Workers' Compensation

Knowledge of reserving practices and procedures; in-house litigation procedures; WCAB procedures; and hearing processes

Ability to interpret and apply the provisions of Workers' Compensation laws and determine the liability of the County

Ability to interpret medical and legal briefs and reports

Ability to establish and analyze all relevant data, effect necessary control plans, and bring all claims to equitable conclusion

Ability to evaluate and analyze workers' compensation claims and negotiate/defend to an equitable conclusion

Ability to be a self-starter and work independently

Knowledge of rules, regulations, and laws regarding personal and property liability including, but not limited to, general provisions of California Vehicle Code, State and Federal Government Codes, laws and statutes and legal decisions pertaining to personal and property liability

Knowledge of methods and techniques of subrogation recovery

Knowledge of technical medical terminology related to the cause and treatment of physical injuries

Knowledge of practices and procedures of insurance reserving, risk and experience analysis and statistical record keeping

Ability to gather and evaluate all information pertinent to liability claims and make appropriate recommendations

Ability to develop action plan necessary to implement recommendations with a minimum of guidance

Experience reviewing and processing complex Workers' Compensation, on-the-job injuries, job-related illnesses, physical disability, personal injury, medical malpractice or property damage liability claims

Experience identifying and investigating fraud cases and investigating, adjusting and settling a wide variety of claims

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