Workers' Compensation Claims Technician - Medical Only - County of Riverside
Riverside, CA 92501
About the Job
The County of Riverside's Department of Human Resources is seeking a Workers' Compensation Claims Technician (No Lost Time Desk) to support the County of Riverside Self Insured Workers' Compensation Program. The selected candidate will carry an independent caseload of First Aid, Medical Only, Future Medical Workers' Compensation claims and will also identify, analyze and evaluate workers' compensation claims and/or manage the Return-to-Work program.
The most competitive candidates will have recent experience providing support services to workers' compensation claims department and have knowledge of medical terminology, the State of California Labor Code and Workers' Compensation Laws.
Workers' Compensation Claims Technician is characterized by the assigned responsibility to perform adjusting, investigative, and decision making functions for medical only claims, having no permanent disability issues, up to $3,000. This class is distinguished from the class of Workers' Compensation Adjustor I by the latter's primary responsibility to investigate, adjust, and settle a broad scope of workers' compensation claims that go beyond medical only claims, have a reserve limit of $10,000, and involve permanent disability issues.
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.
EXAMPLES OF ESSENTIAL DUTIES
- Review, investigate, and process "medical only" claims filed against the County; determine the complexity of the claim and identify issues; recommend approval or denial.
- Perform tasks associated with claim filing; set up files; complete appropriate forms and paperwork; make related phone calls to claimants, doctors, and applicable County departments; conduct routine tasks as with claim handling and scheduling medical appointments.
- Review medical reports to ascertain status, need for consultation, additional tests and/or treatment; respond to inquiries, verbally and in writing, received from insurance carriers, doctors, and claimants.
- Maintain and pull diary on medical only claims; pay claims-related medical bills; review file to avoid duplication of payment; post and balance payments; correct trial-posting errors.
- Assist Workers' Compensation Adjustors as needed; may calculate benefits on temporary disability cases and complete notices to payroll based on Adjustor's approval.
MINIMUM QUALIFICATIONS
OPTION I
Medical-Only Claims Adjuster Designation (as defined by California Code of Regulations, Title 10, Chapter 5, Subchapter 3) by achieving one of the following: At least three years in the past five years of on-the-job experience adjusting California workers' compensation claims or medical-only claims.
OR
Completed at least 80 hours of training, with 50 hours conducted in a classroom with an instructor from an accredited college or the Insurance Education Association.
OR
Possess a certificate in Administration of Workers' Compensation from an institution recognized by the California Department of Insurance or the Insurance Education Association.
OR
A certificate for Administrators for Self-Insurance Plans from the State of California.
OPTION II
Experience: Three years of clerical experience in an insurance, medical or legal environment providing support services to workers' compensation adjusters, which has included setting up files, obtaining information, sorting and processing of materials, maintaining records, and operating a variety of equipment including computers and calculators .
OR
Experience: One year of journey-level experience reviewing and processing workers' compensation, on-the-job injuries, job-related illnesses, physical disability, or personal injury claims. Candidates who have not achieved the level of a Medical-Only Claims Adjuster Designation (as defined by California Code of Regulations, Title 10, Chapter 5, Subchapter 3) must obtain 80 hours of recognized training, or successful passage of the self-insured test within 12 months of appointment.
Knowledge of: The State of California Labor Code and Workers' Compensation Law; medical terminology, anatomy, and technical terminology used in the medical and legal fields regarding industrial cases; payroll and audit methods; average recovery time for various types of diseases and injuries; medical claims processing; The State of California Official Medical Fee Schedule.
Ability to: Interpret and apply the provisions of workers' compensation laws and determine the liability of the County; analyze problems and to take effective courses of action; maintain cooperative relations with departmental personnel; establish and analyze all relevant data, effect necessary control plans, and bring all claims to equitable conclusion; communicate effectively orally and in writing; interpret and apply the State of California Official Medical Fee Schedule; operate a personal computer and related peripheral equipment.
SUPPLEMENTAL INFORMATION
Other Requirements
Telework Hybrid options available after training requirements have been met.
License/Certificate: Possession of a valid California Driver's License.
Candidates who have not achieved the level of a Medical-Only Claims Adjuster Designation (as defined by California Code of Regulations, Title 10, Chapter 5, Subchapter 3) must obtain 80 hours of recognized training, or successful passage of the self-insured test within 12 months of appointment.
Veterans' Preference
The County of Riverside has a Veteran's Preference Policy (Download PDF reader) (Download PDF reader) . Upload a copy of your (or your spouse's) Member-4 Form DD-214 (or NGB-22) indicating dates of service, and a copy of your spouse's letter of disability (if applicable) with your application. For privacy reasons, it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans' preference.
Reasonable Accommodations
The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation, please visit the Disability Access Office web page located at: http://dao.rc-hr.com/ .
Degree Verification:
Prior to the closing date, upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account. If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services ( NACES )or Association of International Credential Evaluators, Inc. ( AICE ).
What's Next?
This recruitment is open to all applicants. Current Riverside County Employees with the Human Resources Department may be considered before other applicants depending on the volume of applications received. Applications received prior to the closing date will be considered based on the information submitted. Changes or alterations cannot be accepted. No late applications will be permitted.
Applicants who fail to provide information demonstrating they possess the position requirements may not be considered further in the application process. A description of job duties directly copied from the job classification or job posting will not be considered. Based on the number of applications received, this posting may close or be extended without notice.
Qualified applicants may be considered for future vacancies throughout the County.
BASED ON THE NUMBER OF APPLICATIONS RECEIVED, THIS POSTING MAY CLOSE WITHOUT NOTICE.
GENERAL INFORMATION
If you have any questions regarding this posting, please contact Angela Tavaglione at atavaglione@rivco.org .
If you are experiencing technical problems, you may contact the governmentjobs.com applicant support desk Monday through Friday, 6 am to 5 pm Pacific Time at support@governmentjobs.com or toll-free 1-855-524-5627.
GENERAL APPLICATION INFORMATION:
Please read and follow any special application instructions on this posting. Click the 'Apply' link located on this page to submit your application. For instructions on the application process, examinations, Veteran's preference, pre-employment accommodation or other employment questions, please refer to our web site, www.rc-hr.com . A pre-employment physical examination and background check may be required.
MEDICAL/DENTAL INSURANCE: A choice of different medical, dental and visions plan are available to elect. The County provides a Flexible Benefit Credit contribution, as governed by the applicable Management Resolution, to contribute towards the cost of these plans. Vision coverage is provided through Vision Service Plan (VSP) at no cost to employee or eligible dependents.
Note: Employees on assignment through the Temporary Assignment Program (TAP) receive different benefits. See the list here .
MISCELLANEOUS RETIREMENT: County of Riverside has three retirement Tiers through the California Public Employees' Retirement System (CalPERS).
- Tier I (Classic Member - Formula 3% @ 60): Applicable to current and former County of Riverside local miscellaneous employees hired prior to 08/24/2012 and did not withdraw CalPERS contributions. The employee contribution is eight (8%) percent.
- Tier II (Classic Member - Formula 2% @ 60): Applicable to local miscellaneous employees 1) hired after 08/23/2012 through 12/31/2012; 2) Previously employed with another CalPERS contracting public agency or a reciprocal retirement system, with a break in service of less than six months between the separation date with the previous employer and the appointment date with the County of Riverside. The employee contribution is seven (7%) percent.
- Tier III (PEPRA New Member - Formula 2% @ 62): Applicable to CalPERS local miscellaneous new members hired on or after the implementation of the Public Employees' Pension Reform Act of 2013 (PEPRA) which took effect January 1, 2013. As of July 1, 2020, the employee contribution is 7.25% and subject to change annually.
A new member is defined as any of the following:
CalPERS refers to all members that do not fit within the definition of a new member as "classic members".
Contribution rates are subject to change based on the County of Riverside annual actuarial valuation.
Note:
This summary is for general information purposes only. Additional questions regarding retirement formulas can be sent to retirement@rivco.org or by calling the Benefits Information Line at (951) 955-4981,
Option 2.
If you have prior service credit with another CalPERS agency or within agencies, please contact CalPERS at (888) 225-7377 to determine which retirement tier would be applicable to you. CalPERS is governed by the Public Employees' Retirement Law. The Retirement Law is complex and subject to change. If there's any conflict between this summary and the law, the law will prevail over this summary.
DEFERRED COMPENSATION: Voluntary employee contribution with a choice between two 457 deferred compensation plan options.
401(a) MONEY PURCHASE PLAN: County contribution of $50 per pay period towards choice between two 401(a) plan providers.
VACATION ACCRUAL (Bi-Weekly Accrual):
0 through 3 year = 80 Hours (10 Days)
4 to through 9 years = 120 Hours (15 Days)
10 or more years = 160 Hours (20 Days)
Maximum Vacation leave accumulation is 480 hours.
SICK LEAVE: Four (4) hours Sick leave accrual per pay period with unlimited accrual.
HOLIDAYS: Normally 12 paid holidays per year.
BEREAVEMENT LEAVE: Allowed 5 days (3 days are County paid; 2 days can be taken from use of accrued Sick leave balance).
BASIC LIFE INSURANCE: $50,000 of term life coverage. Premiums are paid by the County. Additional Supplemental Life plan is available for employee purchase.
LONG-TERM DISABILITY (LTD): Benefit pays 66.67% of earnings to a maximum of $10,000 per month; 30-day waiting period; pays to age 65. Benefit may be coordinated with other available leave balances to provide up to 100% of pay.
POST RETIREMENT MEDICAL CONTRIBUTION: A monthly contribution is made by the County towards retiree health insurance offered through the County as governed by the Management Resolution or applicable bargaining unit.
OTHER: There may be other benefit provisions as specified in the applicable Memorandum of Understanding, Management Resolution, or Salary Ordinance. Please contact the recruiter listed on the job posting directly for more information.