Consultant, Claims

About the role

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.

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.
• Maintains and updates knowledge of relevant laws, regulations, and industry standards.
• 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.
• 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.
• Assists other personnel as may be required for the purpose of ensuring an efficient and effective work environment.

Qualifications

• 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.

Skills

• Excellent organizational and attention to detail skills.
• Strong analytical and problem-solving abilities.
• Effective communication and interpersonal skills.
• Proficiency in Microsoft Office Suite.
• Knowledge of the Washington State Workers' Compensation system.

Benefits

We Offer Comprehensive Benefits:

• Medical, dental, and vision through the School Employees Benefits Board (SEBB) Program
• 24 annual leave days per year
• 12 sick days
• 12 paid holidays
• Participation in Washington State Department of Retirement System
• Tax Sheltered Annuity Plan
• Subsidized ORCA card, free parking, and access to EV car charging stations (Renton office)

Pay

Salary range: $50,000 - $70,000 annually

Schedule

Full-time position, Monday through Friday, 8:00 AM - 5:00 PM