ESD 113-Senior Claims Adjudicator-Workers Compensation

Senior Claims Adjudicator

Best to apply by 4/18/2026. Job open until filled.

This position is 260 days/year, 8 hours/day. Work calendar is Monday- Friday.

Benefits include: Medical/Vision/Dental Insurance; FSA/DCAP; Life/AD&D Insurance; LTD Insurance; EAP; Retirement; DCP; Annual/Sick Leave, Holiday Pay and Personal Leave.

Required attachments: Transcript, Resume and Cover Letter

Please see the job description below for a list of Essential Functions.

Purpose Statement

The job of Senior Claims Adjudicator is done for the purpose/s of evaluating eligibility and processing workers compensation claims in compliance with WCT and state regulations; documenting actions; conveying information regarding claims and benefits; providing testimony as may be required in benefit disputes and acts in the capacity of Claims Administrator as directed in that person's absence; and operating relatively autonomously in bringing claims to closure.

This job is distinguished from similar jobs by the following characteristics: Per the essential functions and educational requirements listed below.

This job reports to Workers' Compensation Claims Administrator

Essential Functions

Claims Adjudication Adjudicates worker compensation and related benefit claims (e.g. validity, compensation amount, medical aid benefits, closure of claims, etc.) for the purpose of ensuring fair and thorough treatment of claims while complying with district, state, and federal policies and regulations.

Claims Analysis Analyzes a variety of claims-related information and processes (e.g. workers compensation claim status, litigation and sidebar cost, benefit eligibility, etc.) for the purpose of determining exposure, identifying high cost areas, and developing plans for remediation.

Meeting Attendance Attends a variety of meetings (e.g. legal training on compensation and related benefits disputes, seminars, conferences, continuing education courses in workers' compensation, etc.) for the purpose of ensuring information is shared and received.

Stakeholder Collaboration Collaborates with a variety of stakeholders (e.g. other staff, ESD 113 Safety & Health team, defense counsel, etc.) for the purpose of developing solutions to resolve concerns while meeting the goals of the program.

Record Maintenance Maintains worker compensation files and records for the purpose of documenting actions and ensuring compliance with district policies, and state and federal regulations.

Document Preparation Prepares a variety of information, documents, and files (e.g. statistical summaries, evaluations, reports to excess carrier, written summaries, etc.) for the purpose of providing information and documenting activities.

Information Processing Processes a variety of complex information (e.g. employability assessments, claims information required, conservatory procedures, legal files going to legal authorities, etc.) for the purpose of ensuring employees are treated fairly while complying with district, state, and federal policies and regulations.

Attendance Regular and reliable attendance is required for the purpose of maintaining department operations.

Trust Representation Represents the trust in a variety of situations (e.g. in mediation at the Board of Industrial Insurance Appeals, etc.) for the purpose of providing accurate and responsible representation of the trust.

Research Researches a variety of work-related topics (e.g. relevant policies, current practices, claims data, changing federal requirements, etc.) for the purpose of providing information and recommendations to the district.

Inquiry Response Responds to inquiries from a variety of stakeholders regarding worker compensation and employee benefits (e.g. employees, regulatory personnel, insurance companies, etc.) for the purpose of facilitating communication among parties and providing information and direction.

Order Review Reviews determinative orders for the purpose of ensuring the accurate representation of the Trust's interpretation of the facts of a claim and appropriate actions taken as warranted.

Training Trains claims adjudicators for the purpose of providing orientation for new claims adjudicators and encouraging the development of professional skills.

Marginal Functions

Personnel Assistance Assists other personnel as may be required for the purpose of supporting them in the completion of their work activities.

Related Duties Performs other related duties as assigned for the purpose of ensuring the efficient and effective functioning of the work unit.

Job Requirements: Minimum Qualifications

Skills, Knowledge and Abilities

Skills Required Skills are required to perform single, technical tasks with a need to occasionally upgrade skills in order to meet changing job conditions. Specific skill based competencies required to satisfactorily perform the functions of the job include: operating standard office equipment including pertinent software applications; and preparing and maintaining accurate records.

Knowledge Required Knowledge is required to perform basic math, including calculations using fractions, percents, and/or ratios; read technical information, compose a variety of documents, and/or facilitate group discussions; and solve practical problems. Specific knowledge based competencies required to satisfactorily perform the functions of the job include: worker compensation programs; state and federal worker compensation regulations and laws; medical and legal terminology related to worker compensation; industrial insurance laws, medical aid rules, fee schedules, and appeals procedures; and basic anatomy and physiology.

Abilities Required Ability is required to schedule a number of activities, meetings, and/or events; routinely gather, collate, and/or classify data; and consider a number of factors when using equipment. Flexibility is required to independently work with others in a wide variety of circumstances; analyze data utilizing a variety of complex processes; and operate equipment using a variety of standardized methods. Ability is also required to work with a significant diversity of individuals and/or groups; work with data of widely varied types and/or purposes; and utilize a variety of job-related equipment. Problem solving is required to analyze issues and create action plans. Problem solving with data requires analysis based on organizational objectives; and problem solving with equipment is moderate.

Specific ability based competencies required to satisfactorily perform the functions of the job include: communicating with diverse groups; working with frequent interruptions; working with detailed information; maintaining confidentiality; establishing effective relationships; adapting to changing work priorities; thinking analytically and critically; and willing to travel throughout the Worker Compensation Trust service area.

Responsibility

Responsibilities include: working under limited supervision using standardized practices and/or methods; directing other persons within a small work unit; monitoring budget expenditures. Utilization of resources from other work units may be required to perform the job's functions. There is some opportunity to impact the organization's services.

Work Environment

The usual and customary methods of performing the job's functions require the following physical demands: occasional lifting, carrying, pushing, and/or pulling, some stooping, kneeling, crouching, and/or crawling and significant fine finger dexterity. Generally the job requires 85% sitting, 5% walking, and 10% standing. This job is performed in a generally clean and healthy environment.

Education and Experience Requirements

Experience: Job related experience with increasing levels of responsibility is required.

Education (Minimum): High school diploma or equivalent.

Equivalency: AA degree and 5 years' experience in claims adjudication is preferred, though may be waived in lieu of nay combination of education and experience that provides the required knowledge, skills, and abilities of the position. Must hold a valid WA State Self-Insured Claims Administrator certification, per WAC 296-15-360.

Position Information

FLSA Status: Non Exempt

Salary Grade: 56

Required Testing, Certificates and Licenses

Required Testing:

• None Specified

Certificates and Licenses:

• Valid Driver's License and Evidence of Insurability
• Valid WA State Self-Insurance Certification at time of hire or promotion

Continuing Education and Training:

• Maintains Certificates and/or Licenses
• Recertification test every 5 years

Clearances:

• Criminal Justice Fingerprint/Background Clearance
• WA State Sexual Misconduct Disclosure Release

Capital Region ESD 113 is an Equal Opportunity Employer