Santa Ana Unified School District
Claims Examiner
Santa Ana Unified School District, Santa Ana, CA, United States
About the Employer
Founded in 1888, the Santa Ana Unified School District (SAUSD) is the second largest school district in Orange County serving approximately 36,000 students and the 2nd largest employer in Santa Ana, providing job opportunities to approximately 5,000 employees. SAUSD is comprised of 34 Elementary, 6 Intermediate, 4 Alternative Educational Options, 6 High Schools, 1 dependent charter, 1 child development center, 2 early childhood education programs and 1 Deaf and Hard of Hearing Regional Program K-6.
SAUSD is committed to providing each of its students with a high-quality education, rigorous and advanced programs, and a nurturing, safe environment with state-of-the-art facilities, 21st century learning and technology, and a direct pathway to college upon graduation. Our district proudly boasts one of the highest graduation rates in the state of California.
Job Summary
Under direction of the Director of Risk Management, receive and administer claims made against the District's self-insurance program, including workers' compensation claims, liability claims and property claims. Direct investigations, pursue subrogation opportunities, calculate and pay benefits, direct attorneys representing the District on litigated claims, pay appropriate amounts to medical providers and vendors, maintain a pro-active settlement program.
Job Description / Essential Elements:
SANTA ANA UNIFIED SCHOOL DISTRICT
CLAIMS EXAMINER
BASIC FUNCTION:
Under direction of the Director of Risk Management, receive and administer claims made against the District's self-insurance program, including workers' compensation claims, liability claims and property claims. Direct investigations, pursue subrogation opportunities, calculate and pay benefits, direct attorneys representing the District on litigated claims, pay appropriate amounts to medical providers and vendors, maintain a pro-active settlement program.
DISTINGUISHING CHARACTERISTICS:
Has highly developed written and oral communication skills in handling casualty and property claims. Possesses an in-depth knowledge of relevant law (including statutory, case, and regulatory law) and extensive medical knowledge. Works competently in the administration of a large number of litigated and complex claims. Proficiency in written and oral Spanish as well as English is highly desirable.
REPRESENTATIVE DUTIES:
Determine District's legal obligation to claimant. E
Investigate questionable claims. E
Defend against false and fraudulent claims. E
Calculate and authorize payment of work comp benefits. E
Select and mail appropriate benefit notices. E
Adjust and authorize bills for payment. E
Establish and maintain proper work flow. E
Prepare reports, memos, and letters. E
Identify safety hazards. E
Maintain a file diary. E
Perform related duties as required.
CLAIMS EXAMINER: (Continued)
KNOWLEDGE AND ABILITIES:
KNOWLEDGE OF:
Workers' compensation law and procedures.
Liability and property law.
Civil litigation procedures.
Medical terminology and procedures as they relate to casualty claims.
Computer claim software and word processing software.
KNOWLEDGE AND ABILITIES (CONTINUED)
ABILITY TO:
Establish rapport and communicate articulately with others.
Work with minimal supervision to solve problems and settle claims.
Interpret and apply statutes, regulations, and case law.
Understand and rate medical reports.
Set realistic case reserves.
Meet schedules and time lines.
Operate computers, fax machines, and other office equipment.
Take accident and injury reports.
Perform the essential functions of the job.
EDUCATION AND EXPERIENCE:
Graduation from high school and two years' experience as a claims examiner adjusting lost time and litigated cases.
WORKING CONDITIONS:
ENVIRONMENT:
Office environment with heavy phone traffic.
Constant interruptions.
PHYSICAL ABILITIES:
Hearing and speaking to accurately exchange information in person or on the telephone.
Seeing to read a variety of materials.
Sitting for extended periods of time.
Dexterity of hands and fingers to operate a computer keyboard.
Bending at the waist, kneeling or crouching to file materials.
Lifting or moving objects, normally not exceeding twenty (20) pounds.
Accommodation may be made to enable a person with a disability to perform the essential functions of the job with or without reasonable accommodation.
Board Approved: (8/99 5/01) 5/05
Requirements / Qualifications
EDUCATION AND EXPERIENCE:
Graduation from high school and two years' experience as a claims examiner adjusting lost time and litigated cases.
Please complete the online EDJoin application and attach copies of the following documents:
Resume
High School Diploma (Please scan a copy of High School Diploma and attach it to your application.)
In lieu of the High School Diploma we will accept the following:
Proof of BA Degree (Attach copy of degree or transcripts with degree posted)
THE DOCUMENT SPECIFIED MUST BE ATTACHED IN ORDER FOR YOUR APPLICATION TO BE CONSIDERED FOR EMPLOYMENT.
We will NOT accept ANY faxed or e-mailed attachments.
This position requires a valid High School Diploma or valid equivalency established by an accredited institution/agency within the United States. Applications that do not include a valid degree will not be considered. If you would like to receive credit for a foreign degree, you may submit your foreign degree to an approved education evaluation service. Any cost of evaluation is the candidate's responsibility. For your convenience, you may visit our website at www.sausd.us under the Human Resources link for a list of approved education evaluation services. The District provides this list only as information to prospective job candidates and makes no endorsement on any of the companies listed.
Founded in 1888, the Santa Ana Unified School District (SAUSD) is the second largest school district in Orange County serving approximately 36,000 students and the 2nd largest employer in Santa Ana, providing job opportunities to approximately 5,000 employees. SAUSD is comprised of 34 Elementary, 6 Intermediate, 4 Alternative Educational Options, 6 High Schools, 1 dependent charter, 1 child development center, 2 early childhood education programs and 1 Deaf and Hard of Hearing Regional Program K-6.
SAUSD is committed to providing each of its students with a high-quality education, rigorous and advanced programs, and a nurturing, safe environment with state-of-the-art facilities, 21st century learning and technology, and a direct pathway to college upon graduation. Our district proudly boasts one of the highest graduation rates in the state of California.
Job Summary
Under direction of the Director of Risk Management, receive and administer claims made against the District's self-insurance program, including workers' compensation claims, liability claims and property claims. Direct investigations, pursue subrogation opportunities, calculate and pay benefits, direct attorneys representing the District on litigated claims, pay appropriate amounts to medical providers and vendors, maintain a pro-active settlement program.
Job Description / Essential Elements:
SANTA ANA UNIFIED SCHOOL DISTRICT
CLAIMS EXAMINER
BASIC FUNCTION:
Under direction of the Director of Risk Management, receive and administer claims made against the District's self-insurance program, including workers' compensation claims, liability claims and property claims. Direct investigations, pursue subrogation opportunities, calculate and pay benefits, direct attorneys representing the District on litigated claims, pay appropriate amounts to medical providers and vendors, maintain a pro-active settlement program.
DISTINGUISHING CHARACTERISTICS:
Has highly developed written and oral communication skills in handling casualty and property claims. Possesses an in-depth knowledge of relevant law (including statutory, case, and regulatory law) and extensive medical knowledge. Works competently in the administration of a large number of litigated and complex claims. Proficiency in written and oral Spanish as well as English is highly desirable.
REPRESENTATIVE DUTIES:
Determine District's legal obligation to claimant. E
Investigate questionable claims. E
Defend against false and fraudulent claims. E
Calculate and authorize payment of work comp benefits. E
Select and mail appropriate benefit notices. E
Adjust and authorize bills for payment. E
Establish and maintain proper work flow. E
Prepare reports, memos, and letters. E
Identify safety hazards. E
Maintain a file diary. E
Perform related duties as required.
CLAIMS EXAMINER: (Continued)
KNOWLEDGE AND ABILITIES:
KNOWLEDGE OF:
Workers' compensation law and procedures.
Liability and property law.
Civil litigation procedures.
Medical terminology and procedures as they relate to casualty claims.
Computer claim software and word processing software.
KNOWLEDGE AND ABILITIES (CONTINUED)
ABILITY TO:
Establish rapport and communicate articulately with others.
Work with minimal supervision to solve problems and settle claims.
Interpret and apply statutes, regulations, and case law.
Understand and rate medical reports.
Set realistic case reserves.
Meet schedules and time lines.
Operate computers, fax machines, and other office equipment.
Take accident and injury reports.
Perform the essential functions of the job.
EDUCATION AND EXPERIENCE:
Graduation from high school and two years' experience as a claims examiner adjusting lost time and litigated cases.
WORKING CONDITIONS:
ENVIRONMENT:
Office environment with heavy phone traffic.
Constant interruptions.
PHYSICAL ABILITIES:
Hearing and speaking to accurately exchange information in person or on the telephone.
Seeing to read a variety of materials.
Sitting for extended periods of time.
Dexterity of hands and fingers to operate a computer keyboard.
Bending at the waist, kneeling or crouching to file materials.
Lifting or moving objects, normally not exceeding twenty (20) pounds.
Accommodation may be made to enable a person with a disability to perform the essential functions of the job with or without reasonable accommodation.
Board Approved: (8/99 5/01) 5/05
Requirements / Qualifications
EDUCATION AND EXPERIENCE:
Graduation from high school and two years' experience as a claims examiner adjusting lost time and litigated cases.
Please complete the online EDJoin application and attach copies of the following documents:
Resume
High School Diploma (Please scan a copy of High School Diploma and attach it to your application.)
In lieu of the High School Diploma we will accept the following:
Proof of BA Degree (Attach copy of degree or transcripts with degree posted)
THE DOCUMENT SPECIFIED MUST BE ATTACHED IN ORDER FOR YOUR APPLICATION TO BE CONSIDERED FOR EMPLOYMENT.
We will NOT accept ANY faxed or e-mailed attachments.
This position requires a valid High School Diploma or valid equivalency established by an accredited institution/agency within the United States. Applications that do not include a valid degree will not be considered. If you would like to receive credit for a foreign degree, you may submit your foreign degree to an approved education evaluation service. Any cost of evaluation is the candidate's responsibility. For your convenience, you may visit our website at www.sausd.us under the Human Resources link for a list of approved education evaluation services. The District provides this list only as information to prospective job candidates and makes no endorsement on any of the companies listed.