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Job Title: Workers' Compensation Analyst
Salary: $83,687.04 - $97,467.84 Annually
Location: Hybrid / Office Location: Seattle Municipal Tower, 700 5th Ave., Seattle, WA
Employer: City of Seattle – Seattle Human Resources
The Seattle Department of Human Resources (SHR) endeavors to promote an equitable and engaging work environment so City of Seattle employees can do their best work and make a difference for the people and communities we serve. SHR focuses on providing high quality services to all City employees and departments and works collaboratively with department leaders to align policies, practices, and programs citywide to fulfill the vision of equity and excellence.
Within the department, the Workers’ Compensation unit delivers customer service and proactive claims management to City employees. This unit is responsible for administering the City’s self-insured and self-administered workers’ compensation program with a human centered focus. We are looking for two (2) compassionate and capable Worker’s Compensation Analysts to adjudicate and effectively manage workers’ compensation claims.
The work of this position requires a hybrid combination of in-office and telework. Additional occasional onsite work and meetings may be required, as directed by business needs.
You will be prepared for this role if you have experience or certification in:
- Washington State workers’ compensation claims handling and management, including pertinent guidelines, laws and rules
- Adjudicating workers compensation claims through developed action plans, managing timely reserve adequacy throughout the life of the claim
- Reading and interpreting medical terminology and the Washington Labor and Industries Medical Treatment Guidelines
- Calculating and paying timely benefits as owed, approving timely claim payments and adjustments
- Communicating with a wide variety of people and perspectives, including in situations that require confidently upholding your decision-making
- Managing claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets
- Prepare claims for litigation, including providing testimony as requested, in consultation with the City Attorney Office and unit supervisor
- Certified Claims Administrator (through Washington Department of Labor and Industries)
- Washington Workers’ Compensation Professional designation (WWCP) preferred
The Unemployment Claims Adjudicator position provides unemployment claim adjudication in support of the Washington Hospital Services (WHS)/United Claims Management unemployment program.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Maintain the accuracy and confidentiality of data, records, and files.
- Process paperwork and routine information requests; monitor timely receipt of information from clients and Employment Security Department (ESD).
- Create added-value enhancements to the program and streamline claims processes.
- Act as a lay legal representative for employer clients before the ESD, Office of Administrative Hearings, Commissioner’s Review Office, and the District Tax Office.
- Identify and prepare key witnesses, select and submit evidentiary documentation, make necessary objections, and make oral argument before the Administrative Law Judge (ALJ) for unemployment eligibility hearings.
- Write arguments to persuade the commissioner to affirm or reverse the ALJ’s order, for petitions for review.
- Compile documents for review, file appeals and withdrawals, schedule hearings, request postponements, manage the hearing calendar, and perform other administrative tasks.
- Identify and investigate potential separation and availability issues affecting claimant eligibility for unemployment benefits.
- Request information from and provide information to both the Employment Security Department and clients.
- Research and review current laws and decisions to expand knowledge base.
- Request, collect, and analyze quarterly wage reports from clients; troubleshoot and resolve account concerns between the client and the tax office.
- Request, collect, and analyze benefit charge reports from clients; assist Director with benefit charge questions.
- Produce quarterly correspondence, charts, reports, and forms for clients using word processing, database, spreadsheet, and graphics software.
- Establish positive and professional working relationships with clients and external contacts.
- Research and answer client questions on unemployment issues within scope of authority and ability while maintaining a high degree of professionalism and customer service.
- Represent the organization at client meetings, professional association meetings and workshops, and in all business dealings.
- Assist in the marketing and presentation of unemployment services to potential clients and in the onboarding process of new clients.
- Supports Workers Comp Program or Claims Assistant as needed.
- Perform other duties as assigned
The Workers’ Compensation Time Loss Adjudicator adjudicates and manages the Self-Insured Public Hospital District and Washington Hospital Workers' Compensation time loss and treatment only claims. This position regulates self-insured workers' compensation claims for compliance with the Industrial Insurance Laws Title 51 (RCW), Medical Aid Rules and other statutes related to industrial insurance.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Adjudicate workers' compensation claims to interpret facts and apply laws to determine claim validity and is responsible for the ongoing appropriate and timely claim management activities necessary to bring resolution at the earliest possible time in a cost-effective manner.
- Calculate monthly gross earnings and daily time loss rates for the purposes of issuing accurate and timely benefit payments.
- Ensure initial disability benefit payments are issued within 14 days of notice of receipt of claim and ongoing benefit payments are issued every 14 days.
- Initiate and complete the 3-point contact within 48 hours of receipt of a new claim.
- Establish initial case reserves for the life of each claim at the time of initial claim review and review case reserves every 60 days making necessary adjustments based upon anticipated indemnity, medical, vocational, legal or other costs.
- Conduct a comprehensive file review, take appropriate actions, and complete a Claim Status Summary Report and written Plan of Action (POA) every 60 days.
- Maintain a current claims diary, defined per performance standards.
- Complete timely review and acknowledge receipt of claim documents, record document note entry, take appropriate action and record actions taken in response to documents received and reviewed.
- Review claim file documents to evaluate need for ongoing disability certification, authorize or deny requests for medical treatment, surgery, diagnostic studies, transfers of medical care, refer for vocational, investigative or legal services and/or submit claim for closure.
- Review determinative orders received from the Department of Labor & Industries for the purposes of ensuring they are accurate and represent our interpretation of the facts of the claim and file timely protests or appeals as warranted.
- Evaluate medical reports to determine appropriate permanent partial disability awards.
- Communicate both verbally, and in writing with Department of Labor & Industries staff, designated hospital contacts, physicians, injured workers, claimant and employer attorneys, and other stakeholders.
- Develop and maintain a professional and positive working relationship with all stakeholders.
- Secure, manage and direct the services of outside specialty providers (e.g., independent medical providers, vocational counselors, nurse case managers, defense counselors, and investigators).
- Identify and update injured worker’s physical restrictions and assist clients in the return to work accommodation process; determine the need for vocational services and approve or deny formal vocational plans.
- Investigate and pursue Third Party subrogation claims.
- Approve medical payments on claim files on a weekly basis.
- Prepare claims for closure with the Department of Labor & Industries or close claims in-house following appropriate procedures.
- Complete claim status reviews with clients on a quarterly basis (telephone, web-based or onsite).
- Work with Unemployment Program and absence management staff on joint accounts to coordinate documentation in an effort to discover fraudulent concurrent claims and reduce costs.
- Work with designated hospital contacts answering questions, educating and updating them on an ongoing basis with regard to their assigned duties.
- Attend and represent Washington Hospitals Services Workers' Compensation Program at self-insured meetings, seminars and other meetings as designated.
- Perform other duties as assigned.
Company Overview: Heartland Nurse Consulting Services, LLC is a small but mighty company who is a leading provider of healthcare management services dedicated to ensuring the well-being of employees injured on the job. With a commitment to excellence and a focus on compassionate care, we strive to facilitate the recovery and rehabilitation process for injured workers while optimizing outcomes for both employees and employers.
Position Overview: We are seeking a dedicated and compassionate Nurse Case Manager to join our team, specializing in Worker's Compensation cases. The ideal candidate will have a strong background in nursing, exceptional communication skills, and a passion for advocating for the needs of injured workers. This role offers the opportunity to make a meaningful impact by guiding individuals through the complex process of recovery and facilitating their return to work. We work in partnership with Puget Sound Educational Service District (PSESD).
- Provide comprehensive case management services for injured workers involved in Worker's Compensation claims.
- Collaborate with healthcare providers, employers, and insurance carriers to develop and implement individualized care plans.
- Conduct thorough assessments of injured workers' medical and vocational needs.
- Coordinate medical treatment, rehabilitation services, and return-to-work initiatives.
- Advocate for the appropriate utilization of resources and services to optimize outcomes.
- Monitor progress, evaluate effectiveness of interventions, and adjust care plans as needed.
- Ensure compliance with regulatory requirements and ethical standards of practice.
- Registered Nurse (RN) license, with a minimum of 1 years of clinical experience.
- Previous experience in Worker's Compensation case management preferred.
- Strong knowledge of medical terminology, treatment modalities, and healthcare delivery systems.
- Excellent interpersonal skills with the ability to build rapport and establish trust with diverse stakeholders.
- Effective problem-solving and critical thinking abilities.
- Proficient computer skills, including experience with electronic medical records (EMR) and Microsoft Office Suite.
- Certification in Case Management (CCM) or willingness to obtain within 24 months of hire.
- Competitive salary commensurate with experience.
- Comprehensive benefits package including dental, and vision coverage.
- Opportunities for professional development and continuing education.
- Supportive work environment with a collaborative team culture.
- Work-life balance initiatives and flexible scheduling options.
Heartland Nurse Consulting Services, LLC is an equal opportunity employer committed to diversity and inclusion in the workplace. We celebrate the unique perspectives and talents of our team members and strive to create an environment where everyone feels valued and respected.