Description

General Responsibilities
Under the general direction of the Assistant Superintendent for Insurance Programs and the Work Comp Operations Manager, adjust, manage, monitor, and handle workers' compensation claims for school districts that are members of the Southwest Washington Workers' Compensation Trust. Claims shall be handled in compliance with the state industrial insurance laws, generally accepted claims, practices and procedures, and the WC Trust policies and procedures.

Salary: 
The full salary range will be $81,265.60- $98.883.20. Offers are made at the beginning of the range.

Assignment:
The position is full time, year round. This position is open until filled with applications received by 5:00 p.m. on Wednesday, April 13, 2026 receiving first consideration.

Essential Functions/Other Functions
Essential Functions:

1. Administer claims, including conducting appropriate investigations and making determination of claim acceptance/denial.
2. Collect information for initial time loss and subsequent time loss, and ensure timely entry of time loss payments into the automated claims system to avoid penalties. Identify components that constitute a notice of claim.
3. Monitor claims to resolve problems and ensure payments and records remain up-to-date and reflect current circumstances. Utilize technical expertise to resolve older, more complex claims.
4. Evaluate and authorize or deny requests for medical treatment and payments for services and reimbursements. 
5. Obtain permanent disability ratings and make decisions regarding payment of permanent disability awards.
6. Evaluate cases to establish and maintain appropriate case reserve amounts and ensure notification to the excess carrier when appropriate.
7. Determine the need for additional vendor services, such as legal, vocational, or nurse case manager. Monitor and provide approvals as needed.
8. Determine applicability of third party liability and pursue recovery when appropriate.
9. Review determinations made by DLI and make decisions on whether protest/appeal is warranted.
10. Ensure all claims are properly finalized and closed in a timely manner with all the necessary supporting documentation. Complete claim closures and audits of files in accordance with applicable law in a timely manner to avoid penalties.
11. Authorize payments for provided medical services. Audit invoices by health care providers against claims and ensure that all payments conform to the Medical Aid Rules and Maximum Fee Schedule.
12. Provide technical assistance to the Workers' Compensation Claims Assistant to ensure compliance with applicable laws and facilitate closure of claims.
13. Maintain regular attendance to carry out the duties and responsibilities of the position.

Other Functions:

1. Attend school district meetings.
2. Keep current on changes from L&I and inform of changes that may affect the program.
3. Support the Loss Control Manager with writing newsletter articles on Workers' Compensation issues.
4. Other duties as assigned.

Requirements

Minimum/Preferred Qualifications & Skills
Minimum Qualifications:

1. High school diploma or GED and ten years of Workers' Compensation claims adjusting experience, including handling litigated and complex claims to resolution.
2. Hold a current Washington State Self-Insured Claims Administrator Certification.
3. Experience providing technical assistance to other members of the Workers' Compensation staff.
4. Experience in the use of automated claims system.
5. Experience conducting and accounting for financial transactions.
6. Experience compiling and analyzing statistical data.

Preferred Qualifications & Skills:

1. BA/BS degree in a related area.
2. Experience in a self-insured environment. 

Working Conditions/Employment Requirements
Working Conditions:

1. Office environment.
2. Travel as required.
3. Flexible work schedule.

Employment Requirements:

1. Successful completion of a criminal history background check through the Washington State Patrol.