Workers' Claims Representative

THIS JOB POSTING WILL AUTOMATICALLY CLOSE UPON THE RECEIPT OF 150 APPLICATIONS

OR

AT THE FINAL FILING DEADLINE, WHICHEVER OCCURS FIRST.

With supervisor approval, incumbents may be eligible for intermittent remote work; however, they must physically reside within the Sacramento region or have the ability to regularly report to a City of Sacramento physical worksite with little notice.

The ideal candidate will be resourceful, collaborative, and solutions-oriented with experience managing complex workers’ compensation claims. Experience working with first responder populations, including police and fire personnel, is highly desirable, but not required, along with an understanding of the unique medical, operational, and return-to-work considerations associated with these roles. The ideal candidate will take a proactive and solutions-focused approach to workers’ compensation, thinking beyond traditional workers’ compensation practices to address treatment barriers and support timely recovery and return to work.

They will communicate effectively with injured employees, medical providers, departmental partners, and maintain a strong commitment to high-quality service, integrity, and proactive case management.

Under general supervision, the Workers' Compensation Claims Representative performs a wide variety of responsible duties in claims adjusting related to the City's self-administered Workers' Compensation Program; provides timely Workers' Compensation benefits pursuant to State of California laws; investigates, evaluates, and settles Workers' Compensation claims against the City of Sacramento; attends mandatory settlement conferences, court hearings, and meetings.

This exempt classification is populated with multiple incumbents. The Workers' Compensation Claims Representative performs the entire range of specialized duties requiring a thorough knowledge of all aspects of the Workers' Compensation Program. When filled from the outside, significant prior experience in adjusting Workers' Compensation claims is required.

General supervision is provided by a Workers' Compensation Claims Supervisor or higher-level management staff.

• Reviews accident and injury reports and Doctor's First Report of Injury forms to determine proper actions under Workers' Compensation laws and regulations; obtains background information; and opens and adjusts claims; pays temporary disability, permanent disability, and life pension benefits to injured employees; or, pays death benefits to dependents; reviews and pays related medical bills; reviews and pays expenses incurred to defend the City in contested claims;
  
  and verifies mileage payment requests, pharmacy reimbursements, and other bills.
• Establishes and maintains monetary case reserves to cover medical costs and projected miscellaneous and compensation costs; prepares written requests for settlements; settles litigated cases that do not require a defense attorney and advises as appropriate; reviews cases for subrogation potential and files related actions.
• Computes permanent disability case ratings and awards; coordinates benefits with other City benefits; prepares information for submission to the Workers' Compensation Appeals Board, Disability Evaluation Unit, and Administrative Director; files appropriate actions such as answers, declarations, pleadings and objections.
• Communicates verbally and in writing with injured employees, their departments, physicians, dependents, attorneys, City safety representatives, Workers' Compensation Appeals Board members, and other interested parties; reviews established claims periodically to prompt action and closure, and/or settlement.
• Sets medical evaluations and coordinates return to work, interactive process, utilization review, independent medical review, and independent bill review; attends mandatory settlement conferences, hearings, and meetings relevant to cases.
• Provides exceptional customer service to those contacted in the course of work.
• Other related duties may also be performed; not all duties listed are necessarily performed by each…