Workers' Compensation Claims Adjuster I/II

The County of Riverside's Human Resources Department is seeking a Claims Adjuster I/II to support the Workers' Compensation Division.

This position will carry a caseload of workers' compensation claims and will be responsible for establishing contact with injured workers, conducting Arising Out of Employment (AOE) and Course of Employment (COE) investigations, and determining if the injuries or illnesses are compensable.

The Claims Adjuster II will also review claims for subrogation, prepare settlement documents, and calculate and approve benefit payments.

Positions in this class series report to the Workers' Compensation Officer and are characterized by responsibility to perform claims casework for the County's various self-insurance programs including general liability, medical malpractice and workers' compensation claims.

Incumbents, within delegated settlement authority, bring such cases to resolution by recommending the acceptance or denial of claims and to adjust cases involving the County's various self-insured programs from the initial report to final resolution.

The level at which the position will be filled is at the Department's discretion and is based on candidate qualifications.

Required: A California Self-Insured Certificate issued by the State of California Office of Self-Insurance Plans (OSIP) is required at the time of application.

Meet the Team!

The Human Resources Department seeks and develops talented professionals that fit a highly engaged and collaborative culture.

Claims Adjuster I

• Workers' Compensation Claims: 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.

• Senior Workers' Compensation Claims: Assigns and reviews the work of Adjusters and Technicians; trains and provides technical assistan...