L&I Workers' Compensation Adjudicator 5

Our Mission: Keep Washington Safe and Working! Our Values: Customer Focus, One L&I, Respect, Diversity, Equity and Inclusion, Learning and Growth, Reliability Job Highlights Do you enjoy research and investigation to make data-driven decisions? Do you have an interest in quality assurance, compliance, and data analytics? If this sounds like you, you have an opportunity to make a difference and come be part of our Self-Insurance team as our next Workers’ Compensation Adjudicator 5 (WCA 5). The individual in this position will perform quality assurance reviews and compliance audits of the worker’s compensation programs of self-insured employers and their third‑party administrator (TPA). This includes assessing design adequacy and operational effectiveness, considering risk management and internal controls to ensure operational performance and accountability of the system. In this role, you will also provide expert consultative services to self‑insured employers, third party administrators, program managers and division executives. The work of this position ties directly to our agency goals and the agency mission To Keep Washington Safe and Working. Responsibilities Conduct performance‑based in‑depth compliance audits. Collaborate on quality management risk assessments and develop annual audit plans. Design specific procedures, checklists, tools and tests to achieve objectives and deadlines. Research and investigate complaints submitted by customers against insurance company failed action allegations. Use computer‑assisted auditing techniques to conduct cross‑system data pulls. Use data analytical techniques to identify trends and anomalies. Independently conduct complex analysis and in‑depth reviews to measure and evaluate compliance with Title 51 (RCW), WACs, policies, and standards of self‑insured employers. Conduct interviews with self‑insurance employer executives and managers, employees and third‑party administrator staff. Develop directive specific training to self‑insured employers. Prepare written reports with executive summary of findings and recommendations for remedial action. Analyze audit findings and assess risk for future nonconformance using independent judgment. And much more! Qualifications Your ability to research, analyze, and evaluate data to draw conclusions and make recommendations supported with facts. Your ability to understand and communicate complex processes clearly, concisely and simplified to others both orally and in writing. Your ability to collaborate and build positive, respectful working relationships with clients and co‑workers. Your ability to exercise expert‑level professional judgment in applying audit practices. Your experience and ability to resolve conflict when dealing with clients who may be angry, distraught, or frustrated. Your critical thinking and attention to detail skills will be assets in this position. Required A Bachelor’s degree AND Four (4) years of experience in adjudicating workers’ or crime victims’ compensation insurance claims or adjudication of time loss payments. OR Successful completion of the Department of Labor and Industries Workers’ Compensation Adjudicator 2 Apprenticeship program AND One (1) year of experience as a Workers’ Compensation Adjudicator 3 or higher. OR Equivalent education/experience. Additional experience working with insurance claims, claims/insurance adjusting, claims investigations, disability management, claims risk management/loss control, medical billing, medical insurance, paralegal personal injury services or paramedical occupations will substitute, year for year, for required education. The ability to take action to learn and grow. The ability to take action to meet the needs of others. Desired One year of specialized experience adjudicating self‑insurance claims. Professional designation as a Self‑Insurance Certified Claims Administrator or the ability to obtain the certification within 6 months of starting this position. One year of specialized experience adjudicating self‑insurance claims. Things You Need To Know To help you maintain a proper work‑life balance, teleworking is one of the work schedule options for this position. L&I also offers flexible custom work schedules. State employees who meet the qualifications will become eligible for a generous retirement package at the end of the employee’s career. Click on the "Benefits" tab to learn more. For this position, telework is allowed depending upon business needs and supervisor approval. The assigned duty station for this position is Tumwater, Washington. For positions where in‑office work is necessary, the frequency of telework will be discussed with the supervisor of the position at the time of offer. Other Information For positions requiring travel, you must have a valid unrestricted driver's license and have insurance if driving a privately owned vehicle on state business. This position is represented by the Washington Federation of State Employees (WFSE). Candidates who are offered a job with L&I must possess work authorization that does not require sponsorship by the employer for a visa now or in the future. The Department of Labor & Industries complies with the employment eligibility verification requirements of the federal employment eligibility verification form, I‑9. The selected candidate must provide proof of identity and eligibility to work in the United States on the first day of employment. Please note: L&I may use this announcement to fill multiple permanent and/or non‑permanent positions. Veterans Preference Applicants wishing to claim Veterans Preference should attach to their application a copy of their DD‑214 (Member 4 copy), NGB 22, or signed verification of service letter from the United States Department of Veterans Affairs. Please blackout any personally identifiable data such as Social Security numbers. For further information, contact L&I’s View email address on click.appcast.io. Diversity, Equity, and Inclusion Employer L&I employees come from all walks of life. We strive to hire great people from a wide variety of backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. We believe in the importance of recognizing the value each of us contributes to the success of the agency mission. Having a diverse workforce is this agency’s greatest resource of strength and knowledge. It is through the combination of talents and abilities that we can pursue finding effective measures to provide the best customer service. We are committed to building a diverse and inclusive workplace for everyone. The State of Washington is an equal opportunity employer. Persons with a disability who need accommodation in the application process or testing process, or those needing this announcement in an alternative format, may call View phone number on click.appcast.io. TTY users should first call 711 to access the Washington Relay Service. You are welcome to include the name and pronoun you would like to be referred to in your materials and we will honor this as you interact with our award‑winning diverse and inclusive organization. Background Check Notice Prior to placement in this position, a background check, including criminal history record will be conducted. Information from your background check will not necessarily preclude employment but will be considered in determining your eligibility to perform the requirements of the position. For more Information If you have any questions regarding this job posting, program, or the agency, please contact Jacque Crawford at View email address on click.appcast.io. #J-18808-Ljbffr State of Washington Dept. of Labor & Industries