City and County of San Francisco

Senior Claims Process Clerk (#1476)

$35.13-$42.69 Hourly / $6,088.00-$7,399.00 Monthly / $73,060.00-$88,790.00 Yearly


Definition

Under general supervision, performs difficult and involved claim processing duties including the analysis of accident reports for determining subrogation on medical and industrial accident claim matters; and performs related duties as required. Requires responsibility for: carrying out and interpreting policies, methods and procedures relating to the processing of medical and industrial accident claims; making regular contacts with hospitals, doctors, members of the system, and other interested parties to exchange information and explain and interpret procedures and regulations regarding processing of medical or industrial accident claims; the preparation of difficult medical and/or industrial accident claim reports and the analysis of claim records and related reports to determine proper action to be taken within the limits of laws, rules and regulations governing such claims.

Examples of Important and Essential Duties

1. Analyzes injury or accident claims involving employees injured in accident cases or suffering an illness or injury due to the act of another person to determine if subrogation is involved; checks accident reports; makes determination that subrogation is involved and sets up subrogation file; refers difficult involved subrogation matters to supervisor for determination; notifies interested parties that expenditures caused by the accident or injury must be taken into consideration when settlement is made; records and audits subrogation payments to determine that correct reimbursement for all medical or surgical payments is made.

2. Maintains records in connection with on the job disability cases and carries out negotiations with the industrial accident commission, correspondence with physicians, referees, letters to employees, and other interested parties.

3. Maintains records of city and county employees who are confined to hospitals as a result of injuries while in the performance of duties; makes entries on records involving posting of all pertinent information regarding dates of admission and discharge, nature of injury, and name of doctor in charge.

4. Makes appointments with specialists for patients reporting new injuries and gives current history on present condition and opinion as to whether or not condition is due to injury received in performance of duty; makes appointments with claim doctors regarding reoccurrence if injury; contacts injured persons regarding follow-up examination; corresponds with doctors requesting progress reports on patients.

5. Makes determination as to amount of money paid on medical and disability claims.

Knowledge, Skills and Abilities

Requires considerable Knowledge of medical and industrial accidents procedures; good knowledge of medical terminology including some familiarity with the human anatomy, surgical procedures and legal terminology.

Requires ability to: deal courteously, effectively and tactfully with a variety of individuals including occasional discussions with mentally disturbed persons; keep accurate, complete, detailed medical and/or industrial claims, reports and records; operate common office machines and equipment.

Experience and Training

Requires completion of high school, supplemented by five years of progressively responsible clerical and office experience relating to industrial accident and medical insurance claims.

Disaster Service Workers

All City and County of San Francisco employees are designated Disaster Service Workers through state and local law (California Government Code Section 3100-3109). Employment with the City requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.

CLASS: 1476; EST: 1/1/1900; REV: 1/1/1900;