Dedicated and compassionate Registered Nurse (RN) with a progressive career history with direct patient care, triage and care coordination in a fast-paced environment. Proven ability to remain calm under pressure and skillfully handle difficult patients and high-stress situations. Consistently developing strong relationships with patients and families through empathetic communication, respectful attitude and excellent customer service.
1. Review, examine, investigate, and analyze workers' compensation claims.
2. Interact with injured employees to ensure awareness and understanding of the workers' compensation process, requirements, and entitlements.
3. Prepare and issue notices in accordance with mandated requirements and regularly review and stay abreast of applicable laws that may impact how claims are processed.
4. Establish claim reserve levels by estimating the cost of each assigned claim; monitor reserves and update amounts as necessary.
5. Coordinate medical treatment for injured employees and provide information to treating physicians regarding employee's medical history, health issues, and job requirements.
6. Identify subrogation potential and pursue the process of reimbursement.
7. Serve as a liaison between medical providers, employees, legal professionals, and City Departments. Inform departments of an injured employee's work restrictions and coordinate appropriate accommodations.
8. Review and interpret doctor's reports to ensure that the appropriate American Medical Association (AMA) guidelines have been applied when reporting disability, impairment, and
9. Compare and reconcile claim records with City payroll records to ensure timely and accurate
benefit payments; retrieve workers' compensation usage information from the financial system,
review timesheets, and resolve discrepancies.
10. Communicate with defense attorneys regarding litigated cases; make recommendations regarding
proposed strategies for claim resolution.
CITY OF SIMI VALLEY
Workers' Compensation Adjuster (Continued)
11. Prepare legal documents for submission to the Workers' Compensation Appeals Board, attend
Board hearings, and respond to requests for clarification, as necessary.
12. Analyze, compute, and process indemnity payments. Audit incoming invoices for accuracy and
13. Coordinate with consultants when conducting AOE/COE (Arising Out of Employment/in the
Course of Employment) investigations.
14. Assist with the Request for Proposal (RFP) process for contracted services; participate in
researching, interviewing, and selecting outside vendors.
15. Develop and maintain internal systems for data collection and entry, financial analysis, and report
generation; create and update spreadsheets, logs, and diary as necessary.
16. Attend and participate in staff meetings and keep supervisor informed of status on all assigned
cases and plan of action. Stay abreast of new trends, pending legislation, and case law related to
17. Assist in supervising volunteers and clerical support staff.
18. Perform related duties as required.
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