Claims Assistant - General Liability & Workers' Compensation

Description

The City of Anaheim is seeking motivated, detail-oriented individuals to join our Risk Management Division as Claims Assistants. We currently have openings in both the General Liability and Workers’ Compensation units.

• General Liability Unit: 1 full-time position
• Workers’ Compensation Unit: 1 full-time position and 1 part-time position*

• The part-time position usually averages 30 hours per week. A minimum number of hours is not guaranteed.

General Liability – This role provides administrative support to the General Liability unit in all aspects of claims processing. The ideal candidate is highly organized, excels at time management, and has the aptitude for strong attention to detail. Candidates must possess experience performing highly complex clerical work involving extensive record keeping, interpretation of policies, documents, and a high level of independence when performing assigned duties. Related public sector experience is desirable but not required.

Essential Functions

The following functions are typical for this classification. Incumbents may not perform all of the listed functions and/or may be required to perform additional or different functions from those set forth below to address business needs and changing business practices.

When Assigned to General Liability:

• Set up new claim files by reviewing claims for completeness, check for previous notice of claim, requesting/pulling general accident or vehicle/ police reports and cross referencing with any similar claims.
• Enter claims into the General Liability System and prepare file, abstract summary face sheet, index card and enter on the claim log.
• Investigate and gather pertinent information to assist in the evaluation of claims; request all known existing reports (i.e. general accident, first aid incident, paramedic, vehicle accident and police reports); list in appropriate index files.
• Evaluate and process low value property claims; evaluate for reasonable cost; goes out in field and investigate claim; determine settlement if claim is sufficient and owed; claims resulting from a contractor, identify the appropriate contractor, obtain copies of insurance documents, put contractor on notice and indemnify the city.
• Evaluate damages for reasonable cost using standard depreciation rules, or use an independent appraiser to assist in the evaluation, when damages are paid by the City.
• Prepare and process a wide variety of forms and letters in the completion of assigned duties; act upon claims, lawsuits and interrogatories within designated time frames.
• Assign claim numbers to all claims declared sufficient by the City Attorney's Office (high volume claims) and route to Claims Examiner for rejection, settlement or further investigation.
• May work with and/or assist professional claims staff by performing various aspects of claims investigation and/or data and evidence gathering.
• Perform related duties and responsibilities as required.

When Assigned to Workers' Compensation:

• Set up claim files by assigning numbers, verifying information on injury form, setting amount of medical reserves required for injury (based upon past practice not predetermined amounts); reviews with Claims Examiner then enters into computer system using Gen Source.
• Independently manage and process all "no lost time" claims (either no lost time or up to three (3) days lost time or medical treatment only); lost time claims, verify return to work or modified work status with treating physician.
• Evaluate and authorize payment and issue checks to doctors, hospitals, pharmacies and all other vendors providing service on a claim; code all bills and tie back to a specific claim number; verify accuracy of bill to type of injury and determine reasonableness of charges; determine which bills are forwarded to a review service for further evaluation of unreasonable charges.
• Advise employee injured on the job of their rights and benefits under Workers' Compensation Laws as to proper procedures to file a claim.
• Review all physician reports and analyze medical diagnosis; determine if applicable to type of injury sustained or if it is a non-industrial injury; advise treating physician if payment is not approved.
• Contact physician and employee to initiate early return to work dates at temporary light duty jobs; obtain physician release for light duty; contact departments for possible light duty assignments.
• Monitor medical progress and set up exams with medical specialists for consultation, diagnostic tests and treatment; extend benefits as necessary; requests narrative reports of status.
• Input, print and separate checks, mail originals and record dates and amounts into individual claim files; balance all payments and verify totals do not exceed reserve established for claim.
• Each pay period, verify all industrial leave hours and dollars; verify employee went to doctor and/or was off on legitimate industrial accident (I.A.) time; if hours appear excessive, contact department for reason; independently determine what hours are appropriate and approve for payment.
• Assist Claims Examiner with specific tasks related to claims administration.
• Perform related duties and responsibilities as required.

Qualifications

Experience: Performing highly complex clerical work involving extensive record keeping, interpretation of policies and a high level of independence of action in performing duties.

Knowledge of: Advanced record keeping policies and procedures; modern office software, equipment, and procedures; proper English usage; basic math and accounting practices; unemployment compensation, safety procedures, worker's compensation, medical terminology and/or general liability depending upon area of assignment.

Ability to: Operate a computer keyboard with accuracy and speed; use required software; work under stringent deadlines; work independently, with limited supervisory oversight; prioritize work; make effective and appropriate decisions; interpret and effectively communicate policies and procedures; read, understand and apply complex materials; compile data and prepare narrative and statistical reports; establish and accurately maintain extensive and complex record keeping systems; review and accurately interpret information; work in a high-volume multi-task environment with numerous interruptions; use proper grammar, spelling and punctuation; work accurately with figures; prepare clear and concise reports, letters and memos; communicate effectively both orally and in writing; deal effectively and professionally with adverse and difficult situations; take decisive action; establish and maintain effective working relationships with those contacted in the course of work.

License/Certification Required: Some positions may require possession of, or ability to obtain, an appropriate valid California Driver's License by date of appointment. Possession of Insurance Education Association certification is desirable. Journey level experience as a Medical Only Adjuster, holding a State of California required designation as a Medical Only Adjuster may be highly desirable.

Supplemental Information

***** IMPORTANT APPLICATION INFORMATION AND INSTRUCTION *****

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Monday, March 16, 2026 at 5:00PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

Candidates must be specific and complete in describing their qualifications for this position. Failure to state all pertinent information may lead to elimination from consideration. Stating "See Resume" is not an acceptable substitute for a completed application. The eligibility list established from this recruitment may also be used to fill the current and/or additional vacancies throughout the City.

The successful candidate will be required to undergo a reference / background check (to include a conviction record) and pass a post-offer pre-employment medical examination (which will include a drug/alcohol screening). The City of Anaheim utilizes E-Verify and new employees must provide documentation to establish both identity and work authorization.

Communication regarding your application and/or status will be sent to the email address listed on your application. Please check your email regularly throughout the recruitment process as you will not receive communications by any other method.

Equal Opportunity Employer

The City of Anaheim offers a range of benefit programs for employees and their eligible dependents. These include health, dental, vision, and life insurance, as well as a variety of voluntary benefits. Programs and benefits amounts vary and are based on bargaining unit, family size, hire date, plan selection, and number of hours worked.

To view the current benefits summary, visit: https://www.anaheim.net/DocumentCenter/View/30970/Benefits-Summary-Full-Time

For additional information about the City's benefits, visit: www.myanaheimbenefits.com

RETIREMENT BENEFITS – The City contracts with the California Public Employees Retirement System (CalPERS) to provide retirement benefits. Retirement formula is based on appointment date and membership status with CalPERS.

Note: Pension contribution limitations are set by CalPERS each calendar year, with compensation limit requirements for Public Employee Pension Reform Act (PEPRA) members and Classic members. Employee contributions will be deposited into a 401(a) account after reaching this limit. Employees with CalPERS membership dates prior to July 1, 1996 are not impacted by these limits.

To view the current limits and additional CalPERS information, visit:
https://www.anaheim.net/DocumentCenter/View/4783/CalPERS-Rates