Career Opportunity

Claims Assistant - Worker's Compensation Division - Department of Human Resources (1209)

Recruitment: RTF0137167-01123758

Published: July 12, 2023

Apply using SmartRecruiters, the City and County of San Francisco's application portal.

About:

Specific information regarding this examination process are listed below:

• Application Opening – Wednesday, July 12, 2023
• Application Deadline – Tuesday, July 25, 2023
• Recruitment ID: PBT-1209-137168
• Compensation Range: $70,824 - $86,112 annually
• Appointment Type: Permanent Civil Service
• Eligible List duration resulting from this examination process will be six (6) months.
• Certification Rule for the eligible list resulting from this examination will be Rule of Ten (10) Scores.
• Exam Type: Combined, Promotive and Entrance

Role description

Under immediate supervision, a 1209 Benefits Technician (Claims Assistant) in the Workers Compensation Division (WCD) performs technical and clerical work in employee benefits specific to Workers' Compensation. This is the entry-level class of the Employee Benefits series, performing technical and administrative support and research and working closely with Workers' Compensation Adjusters (8141) in order to ensure a smooth and seamless delivery of benefits to injured employees and the timely completion of critical, time-sensitive tasks.

The following is a list of essential duties that may be assigned to a 1209 Claims Assistant:

1. Provides support services to Workers’ Compensation Adjusters and Supervisors in processing workers’ compensation benefits and notices.
2. Reviews diaries in Claims Enterprise and/or assignments to evaluate and prioritize payments and other tasks.
3. Pays benefits and provider bills as assigned accurately and in a timely manner. This includes sending state mandated benefit information notices to affected parties whenever benefits are started, stopped, changed, delayed and/or denied.
4. Confirms work status prior to processing benefits and documents notes in Claim Enterprise.  Notify adjuster in a significant change of work status in a timely manner.
5. Processes Independent Medical Review (IMR) packets to MAXIMUS and relevant stakeholders.
6. Sends cover letters, medical records and index of medical records to new treating physician and/or other evaluating physician with a Proof of Service.
7. Sends copy of letters, medical records and index of medical records to the injured worker or applicant’s attorney as instructed.
8. Schedules medical-legal examinations including, but not limited to, sending applicable parties appointment notification, payment of benefits/mileage advance as instructed. 
9. Appropriately and timely documents Claim Enterprise notes with pertinent information obtained from Department contacts. Notify adjuster of any significant updates or changes.
10. Reviews, completes, and processes Worker’s Compensation Medical Only claims as assigned and consistent with WCD claims handling protocol.
11. Provides general information to City employees regarding worker's compensation benefits.
12. Researches, records and accounts for account discrepancies, requested information, payment history, prior claims, overpayments, underpayments, injury information, and adjustments in database.
13. Makes adjustments and creates, updates, inputs, and maintains information in the computer software files and/or in the database.
14. Conducts research on claims to determine appropriate rates to use for payment and refers claims needing further attention to a Workers’ Compensation Adjuster for approval as needed.
15. Performs various calculations to support the determination of worker's compensation benefits.
16. Responds and/or refers to bill review company routine vendor and claimant tracer inquires on unpaid medical invoices.
17. Completes standard form letters and maintains reports, logs, and records as assigned.
18. Communicates with employees, dependents, human resources, and payroll personnel within citywide departments, representatives from outside agencies, medical practitioners, attorney, and other professionals.
19. Effectively communicates and collaborates with Workers’ Compensation Division personnel.

How to qualify

Minimum Qualifications:

• Completion of two (2) years college-level course work.

SUBSTITUTION: Verifiable clerical or technical experience administering employee benefits programs including: researching records, claims adjudication, database maintenance, reviewing forms, performing calculations, and responding to general inquiries may be substituted for the required education on a year-for-year basis. Thirty (30) semester units/forty-five (45) quarter units equal one year of experience.

Desirable Qualifications:

• Possess certificate of completion of foundational Medical-Only Workers Compensation coursework through Insurance Educational Association (IEA) or comparable entity.

Verification:
Applicants may be required to submit verification of qualifying education and experience at any point during the recruitment and selection process. If education verification is required, information on how to verify education requirements, including verifying foreign education credits or degree equivalency, can be found at https://sfdhr.org/how-verify-education-requirements

NOTE: Falsifying one’s education, training, or work experience or attempted deception on the application may result in disqualification from this and future job opportunities with the City and County of San Francisco.

All work experience, education, training and other information substantiating how you meet the minimum qualifications must be included on your application by the filing deadline. Information submitted after the filing deadline will not be considered in determining whether you meet the minimum qualifications.

Resumes will not be accepted in lieu of a completed City and County of San Francisco application. 

Applications completed improperly may be cause for ineligibility or disqualification.

What else should I know?

All your information will be kept confidential according to EEO guidelines.

Analyst Information: If you have any questions regarding this recruitment or application process, please contact the exam analyst Ana Britt at ana.britt@sfgov.org

Selection Procedures

After application submission, candidates deemed qualified must complete all subsequent steps to advance in this selection process, which includes the following:

1. Minimum Qualification Supplemental Questionnaire (MQSQ) - Candidates will be required to complete an MQSQ as part of the employment application. This MQSQ is designed to obtain specific information regarding an applicant's experience in relation to the Minimum Qualifications (MQ) for this position. The MQSQ will be used to evaluate if the applicant possesses the required minimum qualifications.

2. Written Examination (Weight 100%) - Candidates deemed eligible will be invited to a written multiple-choice test designed to measure knowledge, skills and abilities in job-related areas. The multiple-choice exam will be administered either on a computer or in a paper format. Candidates will be notified of the exact date, time and place to report for the written examination. This is a standardized multiple-choice examination and in accordance with Civil Service Rule 111.11.4, inspection privileges do not apply to the questions and answers in this examination. A passing score must be achieved on this examination in order to be placed/ranked on the Eligible List.

Terms of Announcement:

This is a Position Based Test conducted in accordance with Civil Service Rule 111A. Applicants must be guided solely by the provisions of this announcement, including requirements, time periods and other particulars, except when superseded by federal, state or local laws, rules or regulations.  Clerical errors may be corrected and, if so, an amended note will be posted on this official job announcement.

The terms of this announcement may be appealed under Civil Service Rule 111A.35.1. The standard for the review of such appeals is ‘abuse of discretion’ or ‘no rational basis’ for establishing the position description, the minimum qualifications and/or the certification rule.  Appeals must include a written statement of the item(s) being contested and the specific reason(s) why the cited item(s) constitute(s) abuse of discretion by the Human Resources Director. Appeals must be submitted directly to the Executive Officer of the Civil Service Commission within five business days of the announcement issuance date.

Additional Information Regarding Employment with the City and County of San Francisco

• Information About The Hiring Process
• Position Based Testing Information
• Conviction History
• Employee Benefits Overview  
• Equal Employment Opportunity 
• Disaster Service Worker
• ADA Accommodation
• Veterans Preference
• Seniority Credit in Promotional Exams
• Right to Work
• Copies of Application Documents
• Diversity Statement

CONDITION OF EMPLOYMENT:  All City and County of San Francisco employees are required to be fully vaccinated against COVID-19 as a condition of employment. Someone is fully vaccinated when 14 days have passed since they received the final dose of a two-shot vaccine or a dose of a one-shot vaccine. Any new hire must present proof of full vaccination status to be appointed. Any new hire who will be routinely assigned or occasionally enter High-Risk Settings, must provide proof of having received a COVID-19 booster vaccine by March 1, 2022, or once eligible.

The City and County of San Francisco encourages women, minorities and persons with disabilities to apply. Applicants will be considered regardless of their sex, race, age, religion, color, national origin, ancestry, physical disability, mental disability, medical condition (associated with cancer, a history of cancer, or genetic characteristics), HIV/AIDS status, genetic information, marital status, sexual orientation, gender, gender identity, gender expression, military and veteran status, or other protected category under the law.