WORKERS' COMPENSATION REPRESENTATIVE III Job at City of Burbank, CA
TEMPORARY
Under general direction, to perform a variety of professional assignments in connection with the administration of the City’s Workers’ Compensation Program; to administer assigned claims (Medical Only (MO), Indemnity, Future Medical (FM), litigated and more complex claims) filed against the City's Self-Insured and Self-Administered Workers' Compensation Program; to follow established protocols to ensure that claims are handled in the most effective way while delivering a customer-centric claims service; to mentor and train less experienced employees; and perform related work as required.
Reviews examines, investigates, analyzes, and resolves workers’ compensation claims, determines compensability, and reserves ; leads the litigation process; monitors injured employees’ recovery progress and response to treatment to achieve medically approved return to work on limited or full duty status; effectively manages business partners with excess insurance reporting requirements and seeks reimbursement where appropriate; works with rehabilitation specialists on permanent disability cases; makes appropriate changes in benefit delivery due to statutory requirements; makes recommendations on disability retirement cases; monitors the citywide light duty program; coordinates the City’s internal rehabilitation program; processes benefit payment documents; assists in developing strategies for the resolution of assigned cases; assists with litigated cases; advises employees on benefits; consults with physicians and attorneys as necessary; supervises, trains, and evaluates employees; makes effective recommendations regarding hiring, promotions, and transfers; effectively recommends disciplinary action as needed, up to and including termination; directs appropriate staff to issue notices; performs the duties of Workers’ Compensation Representative II.
Employment Standards: Knowledge of workers’ compensation law, regulations, case law, labor code, claims management, and disability rating systems; medical terminology and identification of complex medical conditions; time management and organizational skills; advanced knowledge in complex technical areas such as award calculations, permanent disability (PD) rating, structured settlements, catastrophic claims management, Medicare Set Aside (MSA), advanced knowledge and application of American Medical Association (AMA) Guides; workers’ compensation statutory time frames and benefits and statutory form filing requirements; employee care policies and procedures as they relate to the integration of workers' compensation; principles and practices of sound personnel management and supervision; spelling, grammar, and punctuation. Skill in time management and organizational skills. providing excellent customer service; effective analytical and interpretive skills; estimating and maintaining medical reserves based on treatment history and life expectancy; estimating indemnity benefits based on life expectancy; operating modern computers and related software; effectively managing business partners; computing benefits in a timely and accurate manner; conducting thorough investigations. Ability to understand medical terminology; perform compensability evaluation and determination; effectively negotiate settlements; recognize complex issues; communicate effectively, both orally and in writing; maintain strict confidentiality regarding employee, business partner, and vendor information; meet or exceed closing ratio objectives; exercise sound judgment and critical thinking; prioritize and juggle multiple tasks simultaneously; establish and maintain effective working relationships with supervisors, fellow employees, and the public.
Education/Training: Any combination of education and/or experience that has provided the knowledge, skills, and abilities necessary for acceptable job performance as determined by the City. Example combination includes, but is not limited to graduation from high school or equivalent and four years of experience in workers’ compensation claims management including at least two years’ experience handling California Labor Code §4850 claims
License & Certificates: A valid California Self-Insurance Administrator’s Certificate at time of appointment and obtain a minimum of 20 hours post-designation workers' compensation training every two years as required by the State of California. All required licenses and certificates must be maintained throughout employment in this classification.
A valid California Class “C” Driver’s License or equivalent may be required at time of appointment.
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