Consultant, Claims

3 days ago

Renton WA United States Puget Sound Educational Service District (PSESD) Full time

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.

Open until filled;  please submit a completed application by  best consideration date of 11/3/2024.
 
Puget Sound Workers’ Compensation Trust & Unemployment Pool, under the administrative oversight of Puget Sound Educational Service District (PSESD), is a group self-insured program that provides coverage for, and management of, workplace injuries and unemployment compensation claims for 33 school districts, PSESD, and their 45,000 employees in 6 counties within the state of Washington.
 
Puget Sound Educational Service District (Puget Sound ESD) is one of nine regional educational agencies serving school districts and state approved charter and private schools in Washington. Serving over 39% of Washington’s K-12 public school students, our agency provides critical services designed to ensure that our students are ready to enter school, achieve at high levels in the K-12 system, and succeed in postsecondary endeavors. We are committed to becoming an Antiracist Multicultural Organization driven by equity in education. To learn more about Puget Sound ESD, visit

Essential Functions

  • 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.
  • Embodies the principles and practices that form our culture and commitment to becoming an Antiracist Multicultural Organization for the purpose of meeting the Agency’s END: Success for Each Child and Eliminating the Opportunity Gap by Leading with Racial Equity.
  • 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.
  • Meets with clients for the purpose of conducting claim reviews and addressing related matters as needed.
  • Negotiates monetary claim settlements for the purpose of facilitating claim resolution within established authority level.
  • 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.
  • 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.
 
Other Functions
  • Assist other personnel as may be required for the purpose of ensuring an efficient and effective work environment.
ANTIRACIST LEADERSHIP COMPETENCIES
CULTURAL PROFICIENCY : Articulates and applies historical context of racism and understands the current reality of students and communities of color in order to support racial equity. Actively demonstrates a commitment to supporting equity and inclusion, and serves as an advocate with colleagues, partners, and communities to meet the Agency's End and goal of becoming an Antiracist Multicultural Organization in support of eliminating the opportunity gap.
RACIAL EQUITY ADVOCATE : Recognizes, supports, and engages in dismantling institutional racism. Partners with and is accountable to those with whom we are in a transformational relationship, including children, families, and communities of color.
RACIAL EQUITY MINDSET : Demonstrates awareness of biases, internalized racial superiority and oppression. Leads with a racial equity lens and actively uses the racial equity tool in meaningful ways.
TRANSFORMATIONAL VALUES : Contributes to valuable and positive, antiracist transformation in individuals, organizations, and social systems in an effort to actively progress across the antiracist multicultural institution continuum. Is able to foster a sense of community and shared purpose via collaboration and cooperation with others inside and outside PSESD. Embodies the principles and practices that form the Agency’s culture. Operates from an abundance mentality that recognizes opportunities, and is optimistic and realistic about the future.
 
JOB-SPECIFIC COMPETENCIES
ACCURACY AND ATTENTION TO DETAIL : Ensures work is thoughtfully completed, accurate, and error free to the highest degree possible.
CLAIMS MANAGEMENT : Administers the claims process from start to finish, utilizing case management best practices, risk analysis, critical thinking, and interpersonal skills.
CUSTOMER FOCUS : Commits to clarifying and supporting internal and external customers’ goals and strives to meet their expectations and requirements. Consistently acts with customers in mind. Holds self accountable for providing high-quality, responsive, and personable customer service.
FUNCTIONAL/TECHNICAL SUBJECT MATTER EXPERT: Possesses required functional/technical knowledge and skills to perform job responsibilities. Demonstrates active interest and ability to maintain level of knowledge and enhance and apply new functional skills.
  • 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
  • Origami Claims Management System proficiency
  • Experience executing claim reviews with clients
  • Currently hold or are actively pursuing any claims management related designation
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