Workers' Compensation Claims Adjuster

Thank you for your interest in our employment opportunities. We invite you to apply to be a part of our dynamic team providing quality educational services throughout Southwest Washington and other areas of the state. For more information review the NEOGOVApplication GuideandFrequently Asked Questions.

Under the general direction of the Assistant Superintendent for Insurance Programs and the Work Comp Operations Manager adjust manage monitor and handle workers compensation claims for school districts that are members of the Southwest Washington Workers Compensation Trust. Claims shall be handled in compliance with the state industrial insurance laws generally accepted claims practices and procedures and the WC Trust policies and procedures.

Salary:
The full salary range will be $74568.00- $90.708.80. Offers are made at the beginning of the range.

Assignment:
The position is full time year round.

A complete application will include:

1. Work history going back 10 years (if applicable)
2. At least three professional references contact information
3. A Cover Letter expressing interest in the position
4. A Resume that reflects work experience listed on application
5. Proof of your degree.

Essential Functions:

1. Administer claims including conducting appropriate investigations and making determinations of claim acceptance/denial.
2. Collect information for initial time loss and subsequent time loss and ensure timely entry of time loss payments into the automated claims system to avoid penalties. Identify components that constitute a notice of claim.
3. Monitor claims to resolve problems and ensure payments and records remain up-to-date and reflect current circumstances.
4. Evaluate cases to establish and maintain appropriate case reserve amounts and ensure notification to the excess carrier when appropriate.
5. Identify the need for additional vendor services such as legal vocational or nurse case manager. Monitor and provide approvals as needed
6. Determine applicability of third-party liability and pursue recovery when appropriate.
7. Review determinations made by DLI and make decisions on whether protest/appeal is warranted.
8. Ensure all claims are properly finalized and closed in a timely manner with all the necessary supporting documentation.
9. Complete claim closures and audits of files in accordance with Washington RCWs and WACs in a timely manner to avoid penalties.
10. Obtain permanent disability ratings and make decisions regarding payment of permanent disability awards.
11. Evaluate and authorize or deny request for medical treatment and payments for services and reimbursements.
12. Audit invoices by health care providers against claims and ensure that all payments conform to the Medical Aid Rules and Maximum Fee Schedule.
13. Maintain regular attendance to carry out the duties and responsibilities of the position.

Other Functions:

1. Conduct presentations on claims and related topics.
2. Attend meetings in school districts.
3. Other duties as assigned.

Minimum Qualifications:

1. High school diploma or GED.
2. Hold a current Washington State Self-Insured Claims Administrator Certification.
3. Experience adjusting insurance claims.
4. Experience using an automated claims system.
5. Three years of experience adjusting workers compensation claims.

Preferred Qualifications and Skills:

1. Bachelors degree.
2. Five years of experience adjusting workers compensation insurance claims.
3. Experience in a self-insured environment.

Working Conditions/Physical Requirements:

1. Office environment.
2. Travel as required.

Employment Requirements - ESD job offer is contingent upon satisfying the following:

1. Successful completion of a criminal history and fingerprint check through the WA State Patrol and FBI.

Notice of Non-Discrimination
ESD 112 does not discriminate in any programs or activities on the basis of race religion creed color sex national origin marital status sexual orientation gender expression or identity age honorably discharged veteran or military status the presence of any sensory mental or physical disability or the use of a trained guide dog or service animal by a disabled person. The following individuals have been designated to handle questions and complaints of alleged discrimination:

• Civil Rights compliance Officer: Melissa Kreuder
• Title IX Compliance Officer: Wendy Niehaus
• ADA/504 Compliance Officer: Jeffrey Niess

The above information will be provided in the appropriate language for persons with limited English language skills by contacting the ESD at .