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 $74,568.00- $90.708.80. 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 determinations 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.
4. Evaluate cases to establish and maintain appropriate case reserve amounts and ensure notification to the excess carrier when appropriate.
5. Identify the need for additional vendor services such as legal, vocational, or nurse case manager. Monitor and provide approvals as needed
6. Determine applicability of third-party liability and pursue recovery when appropriate.
7. Review determinations made by DLI and make decisions on whether protest/appeal is warranted.
8. Ensure all claims are properly finalized and closed in a timely manner with all the necessary supporting documentation.
9. Complete claim closures and audits of files in accordance with Washington RCWs and WACs in a timely manner to avoid penalties.
10. Obtain permanent disability ratings and make decisions regarding payment of permanent disability awards.
11. Evaluate and authorize or deny request for medical treatment and payments for services and reimbursements.
12. Audit invoices by health care providers against claims and ensure that all payments conform to the Medical Aid Rules and Maximum Fee Schedule.
13. Maintain regular attendance to carry out the duties and responsibilities of the position.

Other Functions:

1. Conduct presentations on claims and related topics.
2. Attend meetings in school districts.
3. Other duties as assigned.

Requirements

Minimum/Preferred Qualifications & Skills
Minimum Qualifications:

1. High school diploma or GED.
2. Hold a current Washington State Self-Insured Claims Administrator Certification.
3. Experience adjusting insurance claims.
4. Experience using an automated claims system.
5. Three years of experience adjusting workers' compensation claims. 

Preferred Qualifications and Skills:

1. Bachelor's degree.
2. Five years of experience adjusting workers' compensation insurance claims.
3. Experience in a self-insured environment.

Working Conditions/Employment Requirements
Working Conditions/Physical Requirements:

1. Office environment.
2. Travel as required.

Employment Requirements - ESD job offer is contingent upon satisfying the following:

1. Successful completion of a criminal history and fingerprint check through the WA State Patrol and FBI.