ABOUT THE JOB: Under general supervision, performs professional claims management tasks in all areas of workers’ compensation benefits for injured employees, in accordance with the provisions of the Labor Code, California Code of Regulations, Workers’ Compensation Appeal Board, Workers’ Compensation Law of California, and the Education Code.

JOB DUTIES: Receives and responds to inquiries regarding workers’ compensation procedures; establishes and maintains an effective working diary for each workers’ compensation case; authorizes and/or schedules appropriate medical care and refers to and continues to monitor Utilization Review and Independent Medical Review pursuant to the California Labor Code; performs highly complex rating of permanent disability; reviews and sets appropriate fiscal reserves; prepares and issues timely employee notifications; utilizes ancillary services as appropriate for individual cases; maintains effective and ongoing communication with injured employees, supervisors, vendors, attorneys, and medical providers; documents all phone calls and conversations regarding claims; conducts case investigations and maintains related records; meets with injured employees, attorneys, doctors, and vendors; prepares files for legal representation; appears at hearings on behalf of the district; approves and denies bills for payment as appropriate; reports claims to the excess carrier; utilizes specialized software to maintain and document all file activities in an accurate and timely manner; responds to inquires in a timely manner; obtains mandated continuing education to ensure compliance with Federal and State regulations; and trains and leads the technical duties of assigned personnel.

•   Complete Job Description available at www.ggusd.us under Employment/Classified Job Opportunities/Job Descriptions

EMPLOYMENT STANDARDS

Education and Experience: High school graduation or equivalent; and a minimum of five years, equivalent to full time work, adjusting indemnity claims within the last eight years of responsible workers’ compensation experience. Must be designated as an experienced claims adjuster.  A bachelor’s degree in addition to the above experience is highly desirable. Any other combination of training and experience which would likely provide the required skills, knowledge and abilities may be considered.

LICENSE AND CERTIFICATES:  Must possess and maintain a Self-Insurance Administrator Certificate. An Insurance Education Certificate or equivalent is desirable.  Must possess and maintain a valid Class C California Driver License and remain insurable at the standard insurance market rate. You will be required to provide a copy of your Self-Insurance Administrator Certificate by the Oral Rating Exam. 

A SUCCESSFUL CANDIDATE REQUIRES THE FOLLOWING….

Knowledge of: Current labor code, case law, and legal and medical terminology; proper adjudication techniques for indemnity claims; familiarity with administrative rules and regulations regarding self-insured public agencies; investigation techniques and practices; and current methods and techniques for maintaining accurate records of complex issues.

Ability to: Work independently and perform complex clerical tasks; oversee coordination of in-house modified duty plans; interpret and apply laws, rules, and regulations applicable to workers’ compensation; prepare files for litigation; represent the district in hearings and negotiate issues and settlements; learn new or updated computer systems and/or software programs; compose appropriate legal/medical correspondence; use tact and diplomacy in dealing with sensitive situations; establish and maintain effective interpersonal relationships with all levels of district employees, as well as outside professionals; and train and lead the technical duties of assigned personnel.

The Garden Grove Unified School District prohibits discrimination, harassment, intimidation and bullying in educational programs, activities, or employment on the basis of actual or perceived ancestry, age, color, disability, gender, gender identity, gender expression, nationality, race or ethnicity, religion, sex, sexual orientation, parental, pregnancy, family, or marital status, military status or association with a person or a group with one or more of these actual or perceived characteristics.