Worker's Compensation Claims Adjudicator (OPEN & PROMOTIONAL) - Spokane County

Worker's Compensation Claims Adjudicator (OPEN & PROMOTIONAL) Print (https://www.governmentjobs.com/careers/spokanecountywa/jobs/newprint/4663901) Apply ? Worker's Compensation Claims Adjudicator (OPEN & PROMOTIONAL) Salary $59,023.65 - $82,611.81 Annually Location WA 99260, WA Job Type Regular Job Number 24-00213 Department Risk Management Opening Date 09/20/2024 Closing Date Continuous FLSA Non-Exempt + Description + Benefits + Questions Job Summary This position works 37.5 hours per week. Positions allocated to this classification are responsible for adjudication, processing, and reserving claims filed by Spokane County employees. This position provides a variety of complex, confidential administrative duties, is performed with independent judgement and discretion and works directly with Labor & Industries to ensure proper coverage. The position includes reviewing, processing, and adjudicating claims and the management of the Spokane County Self-Insured Worker's Compensation Program in compliance with RCW 51 and WAC 296-20. Work is performed under the direction of the Risk Management Director. TOTAL COMPENSATION: $75,550 - $105,743 annually. Total compensation is an estimate based upon base compensation, median retirement fund contributions, and current employer-paid health and related benefit contribution rates (including medical, dental, life insurance, long term disability, and leave). The actual total will vary depending upon each employee's enrollment choices. Examples of Duties + Adjudicates and monitors all self-administered industrial insurance claims in accordance with Title 51 (RCW) and Medical Aid Rules and other statutes related to Washington State industrial insurance. + Administers provisions of worker's compensation benefits agreements for the purpose of ensuring that appropriate services are provided, monitoring claim costs and resolving claims in a timely manner. + Determines medical aid benefits, sets claim reserves, calculates compensation amounts. Determines eligibility for time loss, LEP payments and permanent partial disability. + Analyzes worker's compensation documentation (e.g. Accident and Injury reports, doctor's reports, pharmacy/medical billing, vocational rehabilitation analysis, permanent impairment disability ratings, etc.) + Confers and assists defense counsel in preparation of cases for litigation as requested. Will attend legal hearings on worker's compensation and related benefit disputes for the purpose of providing testimony and monitoring proceedings as necessary. + Secures services and monitors independent physicians, vocational counselors and other related providers. Attend medical conferences with physicians and nurse case managers. + Develops forms, letters, procedures, etc. for purposes of ensuring provider and claimant compliance with workers compensation Self Insured requirements. Prepares written material for the purposes of documenting activities, providing written references and conveying information. + Evaluates employee status (claim validity, light duty release, subrogation decisions, etc.) as it pertains to worker's compensation. Develop, implement, and monitor early return to workopportunities and coordinate job accommodation with Elected Officials, Department Heads and Human Resources. + Maintain worker's compensation files and records for purpose of documenting actions and ensuring compliance with all regulations, county policies and legal requirements. Manages the department's workers compensation record storage and retention. + Attend WSIA annual and legal conference as well as Labor & Industries annual mandatory Update. Monitor and report on all new legislation and regulation changes. + Authorize, adjust, calculate and process all payments made through Spokane County workers compensation fund. Provide transaction and check registers for all payments. This includes payments to all vendors in each claim as well as reimbursements received, excess insurance recoveries and third-party payments. + Responsible for medical case management, including authorization of curative medical treatment guidelines; interacting with all interested parties, including Department of Labor and Industries for early claim resolution. Must be familiar with Washington State Medical Aid Rules. + Investigates claims, interprets facts, and applies RCW's and WAC's to determine claim validity. + Analyze, prepare and submit quarterly reports, annual reports and OSHA reports as required for all Self-Insured Employers. Submit quarterly loss run to excess insurance carrier for reimbursement on claims that have exceeded policy liability limits. + Prepare and submit all mandatory Section 111 Medicare reporting. Determine Medicare eligibility and entitlement. Responsible for all SEIDRS reporting to Labor and Industries. + Prepare and participate in annual audits with Labor and Industries to ensure program compliance. + Investigate and pursue all third-party subrogation claims. + Use a personal computer for storing and accessing data on claims and industrial insurance statistics. Install all new updates to Icomp software when released. + Scan and upload all billing statements to electronic billing company for processing. Maintains secure medical records, legal documents by scanning to secure Icomp electronic file. + Communicate with employees, Elected Officials, Department Heads and Human Resources on Workers Compensation benefits and claim processes. + Performs other related duties as required. Minimum Requirements + High School diploma or GED equivalent. + Three (3) years' experience managing and processing industrial insurance claims. + Or any equivalent combination of training and/or experience that provides the required knowledge, skills and abilities. LICENSES AND/OR CERTIFICATIONS + At the time of appointment must possess or be able to possess within 6 months of employment, a Certified Claims Administrator certificate, as required by the Washington Department of Labor and Industries. + Requires certification every three years for renewal + Possession of a valid driver's license at time of hire and throughout employment. Selection Factors + Knowledge of effective "light duty" programs. + Knowledge of procedures for conducting internal investigations. + Knowledge of application and interpretation of federal, state and local rules, regulations, codes and ordinances. + Knowledge of research methodologies and analysis. + Knowledge of Risk Management operations, procedures, rules and regulations, safety hazards and precautions. + Knowledge of working within strict confidentiality guidelines and standards. + Skilled in communicating effectively both orally and in writing, sufficient to exchange or convey information and to give and receive work direction. + Skilled in fact-finding, analysis, and problem-solving. + Skilled in the use of a personal computer, internet and related software applications. + Ability to exercise sounds judgment in making decisions and carry out special and general assignments and tasks without direct supervision. + Ability to work with others in a team concept. + Ability to research, analyze and resolve complex problems. + Ability to gather, analyze, evaluate and prepare clear and concise reports and/or recommendations. + Ability to apply judgment and discretion and maintain confidentiality in resolving various and complex workers compensation problems and in interpreting policies and regulations. + Ability to conduct effective investigations and interviews. + Ability to present matters clearly and persuasively before public bodies, hearing officers, arbitrators, management and employees. + Ability to communicate detailed and often sensitive information effectively both orally and in writing. + Ability to interpret and properly carry out general instructions and assignments without direct supervision. + Ability to establish and maintain effective working relations with co-workers, Elected Officials, Department Heads, subordinates, supervisors, employees, physicians, vocational counselors and other related parties. SPOKANE COUNTY Employee Benefits Summary The following is a brief list of benefits available to Spokane County regular employees. Complete information is available from Human Resources Department. This information is subject to change. PAID TIME OFF Spokane County Observed Holidays Up to 10 (ten) paid holidays are observed by Spokane County. PTO Non-represented and a select group of represented employees receive a bank of hours that combine both vacation and sick leave into a paid time off bank. There is no waiting period to use this time and it starts out at almost 2 days per month accrual increasing in accrual rates annually for first 5 years. Vacation For employees with less than five (5) years of continuous service, the accrual rate is 1 day of vacation each month for a total of 12 days per year. After six (6) months, employees are eligible to take accumulated vacation time. (Please note the vacation time accumulation may vary depending on contract language). Sick Leave Sick leave is earned at 1 day per month and can be taken as the days are accumulated. Other Leaves Spokane County provides several other paid leaves such as: bereavement leave, jury duty and military duty leave. INSURANCE BENEFITS Medical Insurance Two plans are currently available: Premera Blue Cross (PPO) and Kaiser Permanente (HMO). Spokane County pays 95% of the premium for full-time employees and 90% of the premiums for spouses and dependents. Premiums are deducted each pay period (pay periods: 15th and last day of the month). 2024 Rates: Premera Employee Only: $38.04 per month Employee & Spouse: $149.52 per month Employee & Family: $209.60 per month Employee & Child(ren): $136.16 per month Kaiser: Employee: $35.92 per month Employee & Spouse: $140.56 per month Employee & Family: $196.06 per month Employee & Child(ren): $128.58 per month Dental Insurance Two plans are currently available: Delta Dental of Washington (PPO) and Willamette Dental (DMO). Spokane County pays 95% of the premium for full-time employees and 90% of the premiums for spouses and dependents. 2024 Rates: Delta Dental Willamette Dental Employee: $5.74 per month Employee: $5.98 per month Family: $11.48 per month Family: $11.96 per month Group Life Insurance The County provides a $25,000 group life insurance policy to employees. The County provides a $10,000 benefit for those represented by 492, 492CS & 492CL. This benefit is paid in full by Spokane County. Long Term Disability Coverage Provides an income protection benefit in the event of a long-term illness or injury at rate of 60% of income up to a maximum of $5,000 per month. Spokane County pays the full premium for this plan. Deputy Sheriff's receive a benefit through their union for disability. RETIREMENT Retirement Plan (401a) Spokane County employees are automatically included in the Washington State Retirement System. Both the employer and the employee contribute to the plan. This retirement plan provides a guaranteed lifetime monthly benefit once vested and eligible for retirement. Additional Retirement Plan Option (457b) Employees may supplement their retirement income and save money on taxes by participating in this optional County program. Roth (after-tax) option is also available through this retirement plan. VOLUNTARY BENEFITS AFLAC Supplemental insurance is optional and is provided by AFLAC to help pay for benefits not covered by major medical insurance. The employee pays 100% of the premium. Travel Assistance Provides additional travel protections anytime you travel more than 100 miles from home. Includes pre-trip information, emergency ticket replacement, and emergency evacuation coverage. This benefit is paid in full by Spokane County. Flexible Spending Plan (FSA) Spokane County sponsors a Section 125 Flexible Spending Account to allow out-of-pocket Medical & Daycare Expenses to be paid with Tax Free Dollars. Premiums are automatically set up pre-tax under the FSA. Voluntary Term Life Insurance Voluntary Term Life Insurance is additional optional life insurance provided through The Standard Insurance. New employees are guaranteed up to $50,000 for self and $20,000 for a spouse with no medical underwriting needed. WORK/LIFE PROGRAMS Employee Assistance Program Employees and their family members are eligible to receive free counseling. There are also benefits relating to financial and legal concerns. Reduced Cost Bus Pass Program Spokane County participates in a program with STA which discounts bus passes to $5 a month. Wellness Programs There are opportunities for nearby exercise programs at reduced cost and education programs around wellness themes including financial well-being, nutrition and stress reduction. Discounts There are local and national discounts available to Spokane County employees. 01 How many years of experience do you have in Workers Comp? 02 Do you have experience with ICOMP? 03 Do you have experience with "Self-Insured" programs? Required Question Agency Spokane County Address 824 N Adams Spokane, Washington, 99260 Phone 509-477-5750 Website http://www.spokanecounty.org/employment