L&I Workers' Adjudicator

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 the 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 tied to our agency goals and the agency mission To Keep Washington Safe and Working.

The Department of Labor & Industries (L&I) is a diverse state agency dedicated to the safety, health, and security of Washington's workers. We help employers meet safety and health standards and inspect workplaces when alerted to hazards. As administrators of the state's workers' compensation system, we are similar to a large insurance company providing medical and limited wage-replacement coverage to workers who suffer job-related injuries and illness.

Our rules and enforcement programs also help ensure workers are paid what they are owed, that children's and teens' work hours are limited, and that consumers are protected from unsound business practices.

Insurance Services is the largest division within the agency and administers one of the premier workers' compensation organizations in the nation serving over 3.8 million employees working for 260,000 employers.

Here is what we are looking for:

• 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 in a clear, concise and simplified way 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.

Some of what you'll do:

• Conduct performance based in depth compliance audits.
• Collaborate on quality management risk assessments and developments of 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!

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.

AND 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…