WSIA provides open employment listings as a service to members. There is a $25 fee to post a position on the Employment Exchange, and ads will be posted for 30 days unless directed otherwise. Ad content supplied by hiring employers. For more information or to post a job, email Kari Heinold or call (360) 754-6416.
The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to mild to moderately complex Workers Compensation claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with injured workers, claimants, policyholders, medical providers, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers.
• Manages an inventory of claims to evaluate compensability/liability.
• Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
• Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.
• Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
• Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
• Performs other duties as assigned.
Primary Location: Kent, WA
Additional Locations: Rocklin, CA; Glendale, CA; Portland, OR; Seattle, WA; Tukwila, WA;
Seattle Human Resources endeavors to promote an equitable and engaging work environment so employees can do their best work and make a difference for the people and communities we serve. Within the department, the Workers’ Compensation unit serves the City’s workforce by providing claims administration and customer service for employees who have sustained work related injuries and illnesses. We are looking for a Workers’ Compensation Supervisor who will provide leadership, supervision, and direct the work of the claims adjudication staff of this energetic and evolving team.
On a day-to-day basis, you will oversee the claims
administration staff of the City of Seattle’s self-insured and self-administered
workers’ compensation program. You will be responsible for providing claims
adjudication oversight, working directly with the team and stakeholders to
achieve effective claim outcomes. You will support the team’s professional
development through regular coaching and feedback, and develop their ability to
proactively identify adjudicative issues and empower them to successfully
resolve these issues. You will work directly to inform program priorities,
deliver core services and process improvements, as well as develop programmatic
strategy and planning efforts that are centered on racial and social justice
principles and equitable outcomes. You will collaboratively to create business
processes that support equitable claim adjudication practices citywide.
- Supervising and managing team member performance and unit relationships.
- Utilizing program metrics to set and communicate performance expectations.
- Overseeing the claims management functions of the program to ensure timely, accurate, and effective handling of workers’ compensation claims.
- Providing reserving oversight authority, making final decisions on escalated adjudicative issues, exercising settlement authority, and obtaining resolution to complicated issues.
- Creating, improving and monitoring adherence to standardized workflows and unit business processes.
- Empowering team members to inform processes that center social justice and equitable outcomes through their work.
In addition to the skills and experience mentioned above, you will need to possess the below required qualifications:
- Six years of progressively responsible experience in Workers’ Compensation claims management OR
- An Associate Degree in Business or Public Administration, Legal, Medical, or a related field and five years of experience in Workers’ Compensation claims management OR
- A Bachelor’s Degree in Business or Public Administration, Legal, Medical, or a related field and four years of experience in Workers’ Compensation claims management
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 and laws. Experience in a self-insured environment is highly beneficial
• Reading and interpreting medical terminology and the Washington Labor and Industries Medical Treatment Guidelines
• Communicating with a wide variety of people and perspectives, including in situations that require confidently defending your decision-making
• Calculating and assigning timely and appropriate reserves to claims; managing reserve adequacy through the life of the claim based on ultimate probable outcome
• Managing claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets
• Washington Workers’ Compensation Professional designation (WWCP) is beneficial
• Certified Claims Administrator (through Washington State L&I) is beneficial
• A Bachelor’s Degree in Business or Public Administration, Legal, Medical, or a related field
• One year of experience in Washington State workers’ compensation claims management for the Workers’ Compensation Analyst role
• Associate Degree in Business or Public Administration, Legal, Medical, or a related field
• Two years of experience in Washington State workers’ compensation claims management for the Workers’ Compensation Analyst role
• Three years of experience in Washington State workers’ compensation claims management for Workers’ Compensation Analyst role
This position is responsible for managing a caseload of approximately 140 worker’s compensation claims to ensure consistency with state WAC, RCW, and Labor and Industries policy and in alignment with company best practices. Claim Manager provides service to clients which maximizes efficiency of their worker’s compensation program. Claim Managers will educate, mentor, and assist employer clients as well as independently perform accident investigation, occupational disease causality assessment/planning, develop and implement return to work programs, provide medical case management oversight and direction, and retrospective rating adjustment planning. Claim Manager will facilitate a variety of services and communication with all associated partners including but not limited to Labor and Industries staff, medical professionals, vocational professionals, and employers. The focus of this job is on achieving results which are aligned with the vision and mission of the organization and its strategic goals.
• Review and analyze all documents pertaining to newly filed worker’s compensation claims including report of accident, chart notes, witness statements, work restrictions, etc.
• Initiate contact with employer clients to discuss new claims, expected duration, return to work, and strategic plan
• Help employer clients identify light duty work and put together job descriptions for appropriate work
• Aid employer clients with accident and validity investigation
• Conduct in depth review and analysis including validity investigation, mechanism of injury, objective findings, wage calculations, return to work strategy and development
• Educate regarding retrospective rating and impact on insurance rates and retro refund
• Create regular detailed strategic plans identifying appropriate actions which drive claims to closure
• Teach employers and assist with making valid offers of employment
• Communicate with medical providers to obtain work restrictions and communicate work available with a variety of different employers
• Advise clients on best practices to maximize efficacy of their worker’s compensation programs
• Research and analyze complex medical materials including MDGuidelines and AMA Guides to make assessments of causation and treatment provided
• Prepare persuasive written and oral arguments to influence actions on a case
• Partner and strategize with other claims managers, attorneys, claims consultants, investigators, group managers, vocational consultants, HR professionals, and employer clients
• Prepare comprehensive claim staffing forms and orally present claim summaries and plans of action to bring claims to closure
• Triage claims and appropriately identify priority issues
• At least five years industrial insurance experience