L&I Workers’ Compensation Adjudicator 3

State of Washington•Thurston County – Tumwater, WA

5d•Hybrid

About The Position

The Department of Labor & Industries is seeking a Self-Insurance Workers’ Compensation Adjudicator 3 (WCA 3). As a WCA3 you will be responsible for providing impartial oversight and expert services to the self-insured community and reducing economic hardship to injured workers by adjudicating benefit requests within the program’s performance measurements and expectations. In this position, you will ensure adjudicative decisions are based on laws, rules, policies, and established work standards. You will be required to make legally binding decisions regarding workers’ benefit entitlement. In addition, you will be responsible for resolving worker disputes, protests, and recommend penalties when appropriate. 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. L&I's Self-Insurance Program is dedicated to supporting employers and protecting workers by providing impartial oversight and timely, expert services to the self-insured community and is located within the Insurances Services division.

Requirements

Bachelor's degree in business administration, public administration or closely allied field AND Two (2) 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 Six (6) months of experience as a Workers’ Compensation Adjudicator 2.
OR Six (6) Years of Equivalent education/experience.
The ability to take action to learn and grow.
The ability to take action to meet the needs of others.
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.
Possess work authorization that does not require sponsorship by the employer for a visa now or in the future.
Must be able to provide proof of identity and eligibility to work in the United States consistent with the requirements of the federal employment eligibility verification form, I-9, on the first day of employment.

Nice To Haves

Adjudicative claim experience in the State Fund sections of the Department of Labor and Industries or the Self-Insured Community.

Responsibilities

Review claim files and apply the law to allow or deny new claims filed for workplace injuries or occupational diseases.
Authorize or deny wage replacement benefits, and if payable, establish the rate of compensation.
Make vocational services referrals to include early return to work, vocational assessments, plan development and approval of vocational retraining plans.
Make determination to allow or deny requests to reopen claims closed for more than 60 days and review and investigate requests for accident fund benefits after the statutory limitations.
Research medical or legal issues for claim file action using RCW, WAC, policies, case law and training.
Authorize or deny a worker’s medical treatment, surgery, independent medical examinations, diagnostic studies, transfer of health care providers, and other types of treatment and reimbursement of worker’s travel expenses using the Medical Aid Rules and department coverage decisions.
Respond to inquiries regarding claim benefits, legal rights, the department’s rules and regulations, and the claim adjudication process.
Prepare a variety of claim file correspondence such as letters and legal orders.
Document all claim interactions and decisions and ensure compliance with laws, rules, policies, and case law.
Document treatment authorizations for medial treatment adjudicator to review and make appropriate payment.
Issue a legal order granting or denying reopening within 90 calendar days.
Issue orders resolving protests and send letters of explanation to all parties.