L&I Workers' Compensation Adjudicator 5

State of Washington•Multiple Locations Statewide, WA

13d•Hybrid

About The Position

The Department of Labor & Industries (L&I) is seeking a Workers’ Compensation Adjudicator 5 (WCA 5) to join their Self-Insurance team. This role involves performing quality assurance reviews and compliance audits of worker’s compensation programs for self-insured employers and their third-party administrators (TPA). The position assesses the design adequacy and operational effectiveness, considering risk management and internal controls to ensure operational performance and accountability. The WCA 5 will also provide expert consultative services to self-insured employers, third-party administrators, program managers, and division executives. This work directly supports the agency’s mission to Keep Washington Safe and Working.

Requirements

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.

Nice To Haves

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.

Responsibilities

Conduct performance-based in-depth compliance audits.
Collaborate on quality management risk assessments and development 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 for self-insured employers.
Prepare written reports with an executive summary of findings and recommendations for remedial action.
Analyze audit findings and assess risk for future nonconformance using independent judgment.