Claims Adjuster II/Senior Claims Adjuster (Senior Workers' Compensation Claims Adjuster)

The County of Riverside Human Resources Department is seeking a Claims Adjuster II/Senior Workers' Compensation Claims Adjuster.

The Workers' Compensation Claims Adjuster is responsible for reviewing, analyzing, and evaluating workers' compensation claims filed against the County.

This position serves as a functional lead, providing training and guidance to Claims Adjusters and delivering workers' compensation training to County stakeholders.

A California Self-Insured Certificate is required.

This role reports to the Workers' Compensation Officer and manages claims from initial filing through final resolution, including recommending acceptance or denial of claims within delegated settlement authority.

The Senior Adjuster also ensures compliance with PRISM (Public Risk Innovation, Solutions, and Management) guidelines, best practices, and state mandates by providing critical audit oversight.

The position identifies performance gaps, training needs, and opportunities for process improvement among Technicians, Adjusters, and Supervisors.

Successful candidates will have extensive journey-level experience in workers' compensation claims, including knowledge of alternative dispute resolution (ADR), labor code, PRISM standards, and state audit processes.

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

Meet the team! The Human Resources Department strives to effectively serve and partner with our community, departments and employees by leveraging best practices and innovation to foster a thriving county.• 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...