L&I Workers' Compensation Adjudicator 5

About the role

The Workers’ Compensation Adjudicator 5 (WCA 5) role at the Department of Labor & Industries (L&I) involves conducting performance-based compliance audits, developing audit plans, and providing expert consultative services to self-insured employers and third-party administrators.

Responsibilities

• Conduct in-depth compliance audits of self-insurance programs.
• Collaborate on quality management risk assessments and develop annual audit plans.
• Design specific procedures, checklists, tools, and tests to achieve audit objectives.
• Research and investigate complaints submitted by customers against insurance company actions.
• Use computer-assisted auditing techniques to conduct cross-system data pulls and 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) and WACs.
• Conduct interviews with self-insurance employer executives, managers, employees, and third-party administrator staff.
• Develop directive-specific training for self-insured employers.
• Prepare written reports with executive summaries of findings and recommendations for remedial action.
• Analyze audit findings and assess risk for future nonconformance using independent judgment.

Qualifications

• 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.
• 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.
• 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.

Desired Qualifications

• One year of specialized experience adjudicating self-insurance claims.

Benefits

State employees who meet the qualifications will become eligible for a generous retirement package at the end of the employee’s career. Click on the “Benefits” tab to learn more.