Senior Claims Adjuster

About the Department

Position Duties

• Receive, review, accept or deny public liability claims including malpractice, property and personal claims; evaluate medical reports and reports of experts to determine extent of liability and damages; evaluate merit of claims and recommend settlement or denial of claims; estimate anticipated settlement value, make adjustments and settle claims within assigned monetary authority. •Provide exceptional customer service to all stakeholders. •Provide high level summaries of complex issues. •Gather and review data, reports, and other claim documentation; request clarifying or additional information; review status and perform necessary follow up. •Conduct investigations to determine circumstances involved in claims against the County; including interviewing witnesses and inspecting the scene of accidents, injuries, or property damage; prepare investigative report of findings. •Investigate difficult and complex public liability claims and those involving a greater degree of sensitivity and/or complexity. •Conduct interviews with parties responsible for damage to County property and injuries to County employees to ensure collection of payments; contact public and private organizations/agencies to obtain collections information; recommend actions necessary to enforce collections including court actions or liens. •Represent the County in small claims actions. •Prepare reports of costs and status on active and closed claims. •Consult attorneys to prepare cases for litigation. Serve as custodian of records; provide subpoenaed records and attest to their validity. •Assist the program supervisor to develop and maintain claims records and computer record keeping systems; assure accuracy conformance to policies and procedures and accessibility of claims records. Assist attorneys in the preparation of complex case for litigation ensuring the availability and accuracy of all necessary documentation.

Minimum Qualifications

• Education: Graduation from an accredited college or university with a bachelor's degree or equivalent education (minimum completed units equaling 120 semester/180 quarter). Experience: Five years of journey-level experience i nvestigating general liability, including litigation experience and managing high exposure and complex files and property claims including adjusting, and settling a wide variety of claims. Knowledge of: Rules, regulations, and laws regarding personal and property liability including, but not limited to, general provisions of California Vehicle Code, State and Federal Government Codes, laws and statutes and legal decisions pertaining to personal and property liability; Methods and techniques of subrogation recovery; Technical medical terminology related to the cause and treatment of physical injuries; Practices and procedures of insurance reserving, risk and experience analysis and statistical record keeping. Ability to: Provide exceptional customer service to all stakeholders, provide high level summary of complex issues, gather and evaluate all information pertinent to liability claims and make appropriate recommendations; Establish and analyze all relevant data, effect necessary control plans, and bring all claims to equitable conclusion; Develop action plan necessary to implement recommendations with a minimum of guidance.
• Experience: Five years of journey-level experience i nvestigating general liability, including litigation experience and managing high exposure and complex files and property claims including adjusting, and settling a wide variety of claims.

Other Qualifications

• Job Competencies: Work Performance Measures • Effectively analyze and interpret federal and state laws affecting claims. • Successfully discern and analyze alternatives in technical situations to assist in problem resolution. • Participate appropriately in meetings as directed by the Workers' Compensation Officer or Liability Claims Program Supervisor. • Accurately assess and calculate claim settlement costs. • Successfully analyze information to determine appropriate strategy. • Succinctly and clearly develop written reports and recommendations as assigned. • Skillfully utilize computer and other available technology to maintain claims records, supporting documentation and technical/legal information. • Meet obligations and commitments. • Effectively investigate a wide variety of claims, data sources, regulations and laws governing claims. • Take appropriate actions after carefully determining and analyzing all relevant factors. • Maintain objectivity and credibility. • Effectively maintain expertise in claims areas impacting the County including legal climate and trends. • Appropriately utilize creative problem solving, investigative and analysis techniques. • Persuasively communicate your findings and recommendations to a variety of audiences including attorneys and insurance representatives. • Successfully prioritize conflicting timelines ensuring that each case or project receives appropriate time and consideration. Other Requirements License: A valid California Driver's License is required at the time of appointment or the ability to arrange transportation for field travel. The incumbent may be required to use a personal vehicle and provide verification of auto insurance coverage as required by the County of Riverside. Schedule : At this time, the position has the opportunity for a hybrid telework schedule based on business need, however job expectations, at times will require in person interaction. Telework may change at any time and you will be expected to report to the office. For questions regarding this recruitment: Please contact Angela Tavaglione at [email protected] or (951) 966-3590. Please allow 1-2 business days for response.
• Job Competencies: Work Performance Measures • Effectively analyze and interpret federal and state laws affecting claims. • Successfully discern and analyze alternatives in technical situations to assist in problem resolution. • Participate appropriately in meetings as directed by the Workers' Compensation Officer or Liability Claims Program Supervisor. • Accurately assess and calculate claim settlement costs. • Successfully analyze information to determine appropriate strategy. • Succinctly and clearly develop written reports and recommendations as assigned. • Skillfully utilize computer and other available technology to maintain claims records, supporting documentation and technical/legal information. • Meet obligations and commitments. • Effectively investigate a wide variety of claims, data sources, regulations and laws governing claims. • Take appropriate actions after carefully determining and analyzing all relevant factors. • Maintain objectivity and credibility. • Effectively maintain expertise in claims areas impacting the County including legal climate and trends. • Appropriately utilize creative problem solving, investigative and analysis techniques. • Persuasively communicate your findings and recommendations to a variety of audiences including attorneys and insurance representatives. • Successfully prioritize conflicting timelines ensuring that each case or project receives appropriate time and consideration.
• License: A valid California Driver's License is required at the time of appointment or the ability to arrange transportation for field travel. The incumbent may be required to use a personal vehicle and provide verification of auto insurance coverage as required by the County of Riverside. Schedule : At this time, the position has the opportunity for a hybrid telework schedule based on business need, however job expectations, at times will require in person interaction. Telework may change at any time and you will be expected to report to the office. For questions regarding this recruitment: Please contact Angela Tavaglione at [email protected] or (951) 966-3590. Please allow 1-2 business days for response.

Benefits

• BENEFIT PROGRAM: MCU MEDICAL/DENTAL INSURANCE: A Flexible Benefit Credit is provided on a monthly basis as governed by the Management Resolution or applicable bargaining unit. 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. Effective July 1, 2023 employee contributions are 7.25% and will increase to 7.75% effective July 1, 2024. A new member is defined as any of the following: A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who has no prior membership in any California Public Retirement System. A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who was a member with another California Public Retirement System prior to that date, but who is not subject to reciprocity upon joining CalPERS. A member who first established CalPERS membership prior to January 1, 2013, and who is rehired by a different CalPERS agency after a break in service of greater than six (6) months. 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 [email protected] 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. ANNUAL LEAVE (Bi-Weekly Accrual): 0 < 36 months = 8.92 Hours 36 to <108 months = 10.46 Hours 108 or more months = 12.00 Hours Maximum Annual Leave accumulation is 1,800 hours. Employee may receive pay in lieu of up to 80 hours per calendar year. Agency/Department Head may approve an additional 80 hours. HOLIDAYS: Normally 12 paid holidays per year. BEREAVEMENT LEAVE: 5 days (3 days are County paid; 2 days can be taken through use of accrued leave balances). 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 can 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.

BENEFIT PROGRAM: MCU

• 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. Effective July 1, 2023 employee contributions are 7.25% and will increase to 7.75% effective July 1, 2024.
• A new member is defined as any of the following:
• A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who has no prior membership in any California Public Retirement System.
• A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who was a member with another California Public Retirement System prior to that date, but who is not subject to reciprocity upon joining CalPERS.
• A member who first established CalPERS membership prior to January 1, 2013, and who is rehired by a different CalPERS agency after a break in service of greater than six (6) months.
• 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

Supplemental Questions