- Reviews, examines, and adjusts Workers' Compensation claims.
- Receives and records all claims and determines compensability.
- Authorizes medical treatment and/or changes of physician, utilizing California State Workers' Compensation law.
- Computes and authorizes payments according to California Labor Code.
- Sets reserves.
- Advises employees and dependents of entitlement to Workers' compensation benefits under State law and District policy.
- Arranges special investigations and medical examinations.
- Advises departments regarding procedures and reporting deadlines involving work-related injuries.
- Contacts injured employee to explain benefits and legal rights under the Labor Code.
- Prepares cases for litigation and subrogation recovery.
- Corresponds with doctors and attorneys.
- Attends Workers' Compensation Appeals Board hearings and authorizes settlements as directed by the Workers' Compensation Manager.
- Serves as custodian of records; produces records and attests to validity under the direction of the court by subpoena.
- Develops documentation for claims reports by requesting substantiating reports from physicians, supervisors, and witnesses.
- Compiles pertinent facts, makes thorough analysis, and arrives at sound decisions.
- May at times oversee work activities of clerical staff and give input on their performance evaluations.
- Travels to sites where presence is required, using personal transportation.
- Performs related duties as assigned.
-
PACE Claims Examiner/Data Specialist
1 week ago
Loma Linda University Medical Center Loma Linda, United StatesJob Summary: The PACE Claims Examiner/Data Specialist is responsible for processing professional and hospital capitated full risk claims in accordance with the individual provider contract and Medicare and Medi-Cal billing guidelines and processes claims. Initiates check run and ...
-
PACE Claims Examiner/Data Specialist
3 weeks ago
Loma Linda University Medical Center Loma Linda, United StatesJob Description · Job Summary: The PACE Claims Examiner/Data Specialist is responsible for processing professional and hospital capitated full risk claims in accordance with the individual provider contract and Medicare and Medi-Cal billing guidelines and processes claims. Initi ...
-
Pace Claims Examiner/data Specialist
3 weeks ago
Loma Linda University Loma Linda, United States**Job Summary**: The PACE Claims Examiner/Data Specialist is responsible for processing professional and hospital capitated full risk claims in accordance with the individual provider contract and Medicare and Medi-Cal billing guidelines and processes claims. Initiates check run ...
-
Claims Examiner Workers Compensation
3 weeks ago
Sedgwick Rancho Cucamonga, United StatesTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
-
Workers Comp Claims Examiner
2 weeks ago
Diedre Moire Corp. Riverside, United StatesPlant Maintenance Tech - Beverage Bottling - Riverside, CA · Maintenance Technician Mechanic Electrician Beverage Bottling Water Filtering Mixers Blenders Carbonators Automated Bottle Fillers Cappers Labelers Boxers PLCs HMIs Motors Rotary & Linear Motion Componenets Hydraulics P ...
-
Workers Comp Claims Examiner
2 weeks ago
Diedre Moire Riverside, United StatesPlant Maintenance Tech - Beverage Bottling - Riverside, CA Maintenance Technician Mechanic Electrician Beverage Bottling Water Filtering Mixers Blenders Carbonators Automated Bottle Fillers Cappers Labelers Boxers PLCs HMIs Motors Rotary & Linear Motion Componenets Hydraulics Pne ...
-
Senior Claims Examiner Workers Compensation
3 weeks ago
Sedgwick Claims Management Services Ontario, United StatesWe are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. ESSENTIAL RESPONSIBLITIES MAY INCLUDE - Analyzing and processing claims through well Workers Compensation, Claims, ...
-
Public Entities Claims Examiner III
2 weeks ago
Tristar Insurance Services LLC Chino Hills, United StatesJob Details · Level · Experienced · Job Location · Chino Hills - Chino Hills, CA · Remote Type · Optional Work from Home · Position Type · Full Time · Education Level · High School Diploma or GED · Salary Range · $80, $95,000.00 Salary · Travel Percentage · None · J ...
-
Audiologist
1 week ago
Clay Consulting, LLC San Bernardino, United StatesJob Introduction · Join a talented team of individuals who serve this country by caring for our Nation's heroes Clay Consulting, a VA (Veterans Affairs) subcontractor, is looking for Audiologists to perform Veteran Audiology Examinations. · Your Role as a Provider · At Clay Consu ...
-
student assistant
4 weeks ago
State of California San Bernardino County, United StatesJob Posting: Student Assistant · Employment Development Department · JC Student Assistant · STUDENT ASSISTANT $ $23.21 per Hour · Final Filing Date: 5/26/2024 · Application Methods: Electronic (Using your CalCareer Account) By Mail Drop-off Job Description and Duties · ...
-
associate governmental program analyst
1 week ago
Department of Transportation San Bernardino County, United StatesJob Description and Duties · District 8 –– 601/2339 Maintenance Support Under the general supervision of a Staff Services Manager I, the Associate Governmental Program Analyst (AGPA) provides technical expertise in a variety of administrative areas in the Maintenance Support Bra ...
-
Auto and Liability Claims Adjuster
2 weeks ago
Elite San Bernardino, United StatesJob Description · Job DescriptionPOSITION SUMMARY: Responsible for the prompt review of claims to determine coverage for loss/damage/injury. Conduct an efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigati ...
-
Principal Workers' Compensation Adjuster
5 days ago
San Bernardino County San Bernardino, United StatesApply by · 5:00 p.m. on Friday, April 19th, 2024 for Priority Consideration for 1st Round Interviews · Earn an Annual Salary Up to $99,548.80 · Salary negotiable commensurate with qualifications. · The · Risk Management Department · is recruiting for a · Principal · Workers' ...
-
Substitute Account Technician
1 week ago
San Bernardino Community College San Bernardino, United StatesSalary: $24.29 Hourly · Location : Various Locations - San Bernardino County, CA · Job Type: Substitute · Job Number: · Department: Various Departments · Opening Date: 07/01/2023 · Closing Date: Continuous · Work Schedule: *Work hours may vary by department needs* · Work ...
-
Mine Safety and Health Specialist
3 weeks ago
Mine Safety and Health Administration San Bernardino, United StatesSummary · Location will be Vacaville, CA; Elko, NV; Henderson, NV; Kent, WA; San Bernardino, CA; Boise, ID; or Albany, OR and is negotiable at selection. · This position serves as a Electrical Specialist and authority on related issues and problems encountered in the mining ind ...
-
Office Assistant III
2 days ago
County of San Bernardino, CA San Bernardino, United StatesSalary: $ $24.75 Hourly · Location : Throughout San Bernardino County, CA · Job Type: Full-time · Job Number: · Department: Multiple County Departments · Opening Date: 01/13/2024 · The Job · iMMEDIATE VACANCIES - APPLY TODAY · San Bernardino County is accepting applications ...
-
Psychiatrist
2 days ago
DAK Resources. Inc Loma Linda, United StatesPsychiatrist · Summary · As an employee operating in a Whole Health System of care, you will operate in a model with three core elements, seeking to create a personalized health plan for each Veteran. This is done in the context of healing relationships and healing environments ...
-
Certified Psychiatrist
1 day ago
DAK Resources. Inc Loma Linda, United StatesVA Clinical Psychiatrist · Summary · As an employee operating in a Whole Health System of care, you will operate in a model with three core elements, seeking to create a personalized health plan for each Veteran. This is done in the context of healing relationships and healing ...
-
Physician (Cardiologist)
1 week ago
Department of Veterans Affairs Loma Linda, United StatesSummary · The Jerry L. Pettis Memorial Veterans Hospital is recruiting for a Full-Time, Permanent, Physician (Cardiologist) and reports directly to the Chief of Cardiology. · Physician (Cardiologist, Non-Invasive) salary range is from $310,000 to $340,000 · Physician (Cardiologis ...
-
Physician (Interventional Radiology)
1 week ago
Department of Veterans Affairs Loma Linda, United StatesSummary · The Jerry L. Pettis Memorial Veterans Hospital is recruiting for a Full-Time, Permanent, Physician (Interventional Radiology) and reports directly to the Chief of Imaging Service. · Learn more about this agency · Help · Overview · * Accepting applications · * Open & clo ...
Claims Examiner - San Bernardino, United States - The Ladders
![Default job background](https://contents.bebee.com/public/img/bg-user-ex-1.jpg)
Description
Salary: $ $44.75 HourlyLocation : San Bernardino City Unified School District, CA
Job Type: Most positions work 8 hours/12 months
Job Number:
Department: Business Services Division
Opening Date: 05/01/2024
Closing Date: Continuous
Job Description
DEFINITION
To perform journey-level specialized and complex technical work in support of the District Workers' Compensation claims program; to examine and adjust claims and monitor claims expenditures.
SUPERVISION RECEIVED AND EXERCISED
Receives general supervision from the Workers' Compensation Manager and functional supervision from a Senior Claims Examiner.
Exercises technical and functional supervision over clerical staff and modified-duty workers in the absence of the Workers Compensation Manager.
Examples of Duties
Duties may include, but are not limited to, the following:
Experience and Education/Training
Any combination of experience and education/training that demonstrates an ability to perform the essential functions of the job. (These ar the minimum experience and education/training standards which will be used to admit or reject applicants for examination, as approved on the date below.)
Two years of Workers' Compensation claims processing experience.
AND
Sixty semester units of college course work supplemented by specialized training or courses in Workers' Compensation laws, claims adjusting, disability ratings, rehabilitation or closely related fields.
(Substitution: Additional experience of the kind indicated in excess of the required two years may be substituted for the required education on the basis of three months of additional experience for five semester units of college course work. NOTE: High school graduation or the equivalent is required of every applicant.)
Licenses/Certificates/Registrations
An appropriate, valid California driver's license and auto liability insurance.*
A California State Certificate to Administer Claims for Self-Insured Employers.**
Additional Information
CLICK HERE TO VIEW THE COMPLETE JOB DESCRIPTION.
DISTINGUISHING CHARACTERISTICS: Differs from Workers' Compensation Clerk in that Claims Examiner performs journey-level Workers' Compensation claims adjustment work while Workers' Compensation Clerk performs specialized clerical duties in support of the District Workers' Compensation program.
LICENSES/CERTIFICATES/REGISTRATIONS:An appropriate, valid California driver's license and auto liability insurance.* A California State Certificate to Administer Claims for Self-Insured Employers.**
SPECIAL REQUIREMENT: Personal transportation for travel to locations where District business requires attendance. *Must be submitted upon offer of employment and maintained throughout employment in this position **Must be submitted within two years of employment in this classification.
RECRUITMENT TYPE: OPEN & PROMOTIONAL (Anyone may apply for this position).
APPLICATIONS: Following closing of recruitment, no additional application material or information will be accepted.
ADDITIONAL SALARY INFORMATION: This is a non-exempt position, Regular Classified Salary Range 46A. Positions in this class work 8 hours 12 months. The probationary period for employees in this classification is six (6) months (or 130 working days of paid service).
BENEFITS: Health, Vision, Dental and PERS (retirement). Benefits are available to full-time and part-time employees.
For complete details visit
THE EXAMINATION: Qualified applicants will be notified of the time and place of the examination.
Training and Experience Evaluation. WEIGHT: 100%
Applicants must achieve a passing score in each part of the examination process in order to be placed on the eligibility list.
Note:
The proposed examination parts may be changed at any time following close of recruitment. Candidates will be notified in accordance with Personnel Commission Rules.
Only online applications are accepted via
Computer access is available in the Personnel Commission Office. This eligibility list will be active for a period of one (1) year.
REASONABLE ACCOMMODATIONS:
The Personnel Commission will make every effort possible to ensure that all applicants compete on an equal level. At any time in the employment process, applicants with disabilities may request reasonable accommodations if required. To give district staff adequate time to evaluate each case, and to arrange for accommodations, applicants must submit their request to the Affirmative Action Office at ([redacted] as soon as possible. Failure to do so may result in the inability to provide the necessary reasonable accommodations in a timely manner.
Fingerprinting, drug and tuberculosis testing is required of all successful candidates new to the district.
District employees and external applicants must submit the required proof of education and/or training with each application by uploading copies of a high school diploma, GED certification (or equivalent), transcripts (official or unofficial), college degree(s), and/or training certificates. If the required proof of education is not attached to the application you may be disqualified. All relevant experience must be clearly indicated in the "Work Experience" section of the application. Resumes will not be considered.
Closing Date: Continuous-subject to close any time.
CLASSIFIED NON-MANAGEMENT EMPLOYEE:
PERS Retirement; Medical, Dental, Vision, and Life Insurance; Vacation, Holidays and Sick Leave. Benefits are available to full-time and part-time employees.
CLASSIFIED MANAGEMENT EMPLOYEE:
PERS Retirement; Medical, Dental, Vision, and Life Insurance. Benefits are based on a 40-hour workweek, 8 hours per day.
SCHOOL POLICE OFFICERS:
PERS Retirement; Medical, Dental, Vision, and Life Insurance. Benefits are based on a 40-hour workweek.
School Police Officers Differential compensation:
POST Intermediate Certification: 6% to base pay
POST Advanced Certification: 8% to base pay
Associate degree: 5% to base pay
Bachelor degree: 7% to base pay
Master degree: 9% increase to base pay
For complete benefit details, please visit