Consultant, Claims

PSESD•Renton, WA

8h•Onsite

About The Position

Puget Sound Workers’ Compensation Trust and Unemployment Pool (PSWCT/UP) seeks a Claims Consultant to evaluate, process, and manage time-loss and medical-only workers’ compensation claims within the guidelines of Washington State industrial insurance laws and regulations, documenting activities, and conveying information regarding claims and benefits. Puget Sound Workers’ Compensation Trust & Unemployment Pool, under the administrative oversight of Puget Sound Educational Service District (PSESD), is a group self-insured program that provides coverage for, and management of, workplace injuries and unemployment compensation claims for 33 school districts, PSESD, and their 45,000 employees in 6 counties within the state of Washington. Puget Sound Educational Service District (Puget Sound ESD) is one of nine regional educational agencies serving school districts and state approved charter and private schools in Washington. Serving over 39% of Washington’s K-12 public school students, our agency provides critical services designed to ensure that our students are ready to enter school, achieve at high levels in the K-12 system, and succeed in postsecondary endeavors. We are committed to becoming an Antiracist Multicultural Organization driven by equity in education.

Requirements

Associate’s Degree in job-related field, or High School diploma/GED and progressively responsible work-related experience
Previous experience managing Washington State workers’ compensation time-loss claims
Currently hold or are actively pursuing Washington State-certified claims administrator designation

Nice To Haves

Origami Claims Management System proficiency
Experience executing claim reviews with clients
Currently hold or are actively pursuing any claims management related designation

Responsibilities

Adjudicates workers' compensation time-loss and medical-only claims for the purpose of complying with legal requirements and state statutes.
Analyzes data for the purpose of establishing reserve amounts and the need for reserve changes.
Attends legal hearings on worker's compensation and related benefits disputes for the purpose of providing testimony and monitoring proceedings.
Authorizes payment to injured workers, vendors, and/or medical providers for the purpose of delivering benefits in accordance with Washington State Industrial Insurance Laws.
Establishes time-loss compensation rates and authorizes payments to injured workers for the purpose of delivering benefits in conformance with Washington State Industrial Insurance Laws.
Evaluates claims submitted for workers' compensation benefits for the purpose of establishing eligibility and course of action.
Identifies and hires outside specialized personnel for the purpose of assisting in the management of claims.
Maintains worker's compensation files and records for the purpose of documenting actions and ensuring compliance with participating District policies and mandated legal requirements.
Meets with clients for the purpose of conducting claim reviews and addressing related matters as needed.
Negotiates monetary claim settlements for the purpose of facilitating claim resolution within established authority level.
Prepares written materials for the purpose of documenting activities, providing written support and/or conveying information.
Provides information to personnel and various third parties for the purpose of documenting actions and ensuring compliance with participating district policies and mandated legal requirements.
Responds to inquiries from claimants, participating districts and/or other involved personnel for the purpose of resolving issues, facilitating communication among parties and/or providing information or directions.
Assist other personnel as may be required for the purpose of ensuring an efficient and effective work environment.