ES Benefit Specialist 2 Insurance Services (In-Training)

As an ES Benefits Specialist 2 you will be a key member of the Operations Team and one of the primary voices of the Paid Family and Medical Leave (PFML) program. You will help Washington workers and employers understand their rights and responsibilities process benefit claims and ensure customers receive timely accurate information. Your work directly supports ESDs mission to provide economic stability and peace of mind during lifes most challenging moments.

In this role you will adjudicate Paid Family Medical Leave benefit claims review documentation for eligibility and guide customers through program requirements. You will respond to a high volume of inquiries from claimants employers healthcare providers and representativesproviding clear explanations resolving issues and escalating concerns when appropriate. You will ensure compliance with RCW WAC and agency policies while delivering exceptional service to diverse customers including those with limited English proficiency.

Some of what you will do:

• Process and adjudicate routine and complex Paid Family Medical Leave claims in accordance with RCW WAC and agency policies

• Provide high-quality customer service through phone email and secure messaging managing large volumes of inbound and outbound communication

• Identify customer needs research issues and deliver accurate timely solutions

• Review wage information identity verification materials and medical certifications to determine benefit eligibility

• Conduct fact-finding and request additional documentation when needed to make legally sound determinations

• Ensure customers with limited English proficiency receive translated correspondence and due process through certified interpreters

• Resolve monetary and non-monetary redeterminations and process weekly claims including corrections or adjustments

• Report potential underpayments overpayments and suspected fraud in accordance with compliance requirements

• Assist employers with Paid Family Medical Leave premium reporting registration and program questions

• Respond to inquiries from claimants employers healthcare providers and other stakeholders regarding program requirements and case-specific issues

** These positions are in-training advancing after successful completion of the in-training plan which includes on-the-job and classroom training.**

To request a detailed position description for the goal class (ESBS2) and in-training plan click here.

Required:

Option 1:Four (4) years of equivalent experience.

Option 2:One (1) year as an ES Benefits Technician AND Three (3) years of additional relevant experience.

Option 3: One (1) year of experience equivalent to the ES Benefits Technician with another state that administers insurance benefits programs AND Three (3) years of additional relevant experience.

Required Equity Competencies:

• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.

Required experience includes:

• Claims Processing and Adjudication:Skill in processing and adjudicating claims.
• Documentation and Verification: Ability to document and verify benefit requests.
• Fact-Finding and Advising: Ability to gather facts and advise on rights and responsibilities.
• Legal Compliance and Decision Making:Ability to make decisions based on laws and policies.
• Program Knowledge and Communication:Ability to explain program requirements and services.
• Problem Resolution and Communication:Skill in resolving issues and communicating outcomes.
• Adaptability Versatility and Task Management: Ability to perform various tasks as needed including those of lower-level positions.

Benefit Specialist In-Training:$49428 - $66372 Annually during training and Benefit Specialist 2: $54504 - $73284 Annually.

Additional Requirement of Employment:

• Must be able to pass Unemployment Insurance (UI) & Paid Family and Medical Leave (PFML) claim and fraud check.

Please submit only the required documents as noted below and ensure all Personal Identifying Information (PII) such as Social Security numbers etc. are edited out of your materials for privacy.

Please submit your Cover Letter and Resume with your Online Application through the Add Attachments field. A resume will not substitute for the work experience section of the application or vice versa. Applications with blank fields or supplemental question responses with comments such as see attachments may be considered incomplete.

Why work with us

Ouragencys mission and values drive every decision that we make determine how we interact with others and are at the core of who we are. We value Access Love Belonging Equity and Stewardship. We understand that a work environment that respects your work/life balance is key; thats why many of our positions are eligible for flexible work schedules and teleworking opportunities. Through support value and trust our employees are empowered to grow and develop into their best self.

Opportunity for All

We strive to create a working environment that includes and respects cultural ethnic racial religious sexual orientation and gender identity diversity. Women racial and ethnic minorities people with disabilities people over 40 years of age people with religious beliefs veterans or people with military status and people of all sexual orientations and gender identities are encouraged to apply.

The Employment Security Department is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities.

If you are a person needing assistance in the application process if you need this job announcement in an alternate format or if you have general questions about this opportunity please contact Katie Swanson or the Talent Acquisition Teamor Washington Relay Service 711 prior to the recruitment closing. If you are having technical difficulties creating accessing or completing your application please contact or or toll free Washington Relay 711.

**This Organization Participates in E-Verify**