Job Details

Job Title

Workers' Compensation Claims Reviewer

Job Description

Reviews, examines and evaluates workers' compensation cases for the determination of appropriate benefits, awards and settlements, and recommends appropriate course of action and strategy in handling the cases; inspects work projects, operations and equipment for compliance with State laws and accepted standards regarding the safety and health of workers; may assist in conducting industrial safety educational and informational programs; and performs other related duties as required.

Examples Of Duties

• Reviews and examines workers' compensation cases for the determination of appropriate benefits, awards and settlements;
• Evaluates workers' compensation claims and recommends employer's course of action;
• Reviews and analyzes reports and data to assist in identifying "accident prone", "malingering" employees, and employees with possible physical impairments;
• Conducts investigation of possible abuse of workers' compensation claims and recommends appropriate action;
• Prepares cases for workers' compensation hearing and may present the case before the hearings officer of the Department of Labor and Industrial Relations;
• Provides guidance and advice to operating agencies in workers' compensation matters;
• Assists in preparation of statistical and activity reports;
• Keeps records of industrial accidents and injuries;
• Inspects work projects and operations and other places of work to detect and eliminate safety, health and fire hazards;
• Inspects equipment, tools, machinery and other devices in use for compliance with State's safety laws, codes and other accepted safety standards and assures that proper protective accessories and apparel are worn by workers;
• Reports violation, recommends correction of unacceptable and hazardous conditions, and refers cases of non-compliance to superior;
• Investigates industrial accident injuries, determines causative factors and circumstances, and submits report recommending corrective actions;
• May assist Risk Management Officer with contract administration;
• Acts as a liaison between the departments and the Third Party Administrator;
• Provides information and attends meetings with the Third Party Administrator;
• Monitors the activities of the Third Party Administrator to ensure thoroughness and timeliness of claims handling;
• Performs other related duties as required.

Minimum Qualification Requirements

Training and Experience: A combination of education and experience substantially equivalent to graduation from an accredited college or university with a bachelor's degree in personnel and industrial relations, business administration, public administration, or a related field, and for: Level I : Two (2) years of progressively responsible work experience in workers' compensation claims, industrial safety and accident prevention activities; License Requirement: Possession of a valid motor vehicle driver's license (equivalent to State of Hawaii, Type 3). Knowledge of: The State Workers' Compensation law, safety laws, and other accepted standards applicable to industrial safety and accident prevention; industrial and construction accident hazards and methods of correction and prevention; common industrial safety devices and equipment; safety inspection principles, practices and procedures; safety education principles and procedures. Ability to: Investigate and determine causes of accidents; make safety inspections and detect unsafe conditions and practices; interpret and enforce pertinent workers' compensation and safety laws, codes, rules and regulations; conduct safety education and instruction courses; deal tactfully with others; prepare clear and concise reports. Health and Physical Condition: Persons seeking appointment to positions in this class must meet the health and physical condition standards deemed necessary and proper to perform the essential functions of the position with or without reasonable accommodations. Physical Effort Grouping: Light

AN EQUAL OPPORTUNITY EMPLOYER

The County of Maui does not discriminate on the basis of race, sex, sexual orientation, age, religion, color, ancestry, national origin, disability, marital status, pregnancy, arrest and court record, assignment of child support, national guard participation or any other basis covered by state or federal laws governing non-discrimination

Pre-Employment/Post-Offer Drug Screening Test : All applicants, who will enter a safety sensitive position or certain designated categories that the Personnel Services Director has established or who are required by law to be drug tested must pass a pre-employment/post-offer drug screening test as a condition of employment. There is no retesting or re-evaluation process. Cost for the drug screening test shall be borne by the County of Maui.

Personnel Services Email: personnel.services@mauicounty.gov