L&I Workers' Compensation Adjudicator 3/Claim Manager

Our Values: Customer Focus, One L&I, Respect, Diversity, Equity and Inclusion, Learning and Growth, Reliability Please Note: This position is open to Internal L&I applicants only. If you apply and are not a current employee, you will not be considered. In the Department of Labor & Industries, Claims Administration Program, the Workers' Compensation Adjudicator 3/Claim Manager, reporting to the Claim Unit Supervisor, independently manages a caseload of State Fund workers' compensation claims filed as a result of work-related injury or occupational illness. The claim manager contributes to the economic well-being of the state by ensuring that injured workers receive sure and certain relief (timely, accurate medical and wage replacement benefits). Washington's State Fund insures 2.7 million employees working for 203,000 employers. We work hard to meet our agency's goal in keeping Washington workers safe and working and the Claims Administration program is currently seeking to fill several Workers' Compensation Adjudicator (WCA) 3/Claim Manager openings. WCA 3 claims are high complexity claims. Caseloads can include injury, occupational illness, and exposure claims with conditions such as head trauma, with brain involvement, amputations, and burns. In addition to injuries from violent crimes, occupational and post-traumatic stress, hearing loss, multiple complex fractures, severe psychiatric conditions, electric shock, respiratory conditions, heart and cardiovascular conditions, complex regional pain syndrome, pension claims with treatment orders, claims over seven years old and with five or more years of time loss compensation.

Duties: Some of what you'll do: Manage a caseload; review and adjudicate industrial insurance claims in accordance with the industrial insurance laws, and case law. Interpret facts and apply the law in determining claim validity and ongoing adjudicative action, meeting all timeliness expectations. Determine need for vocational services, make appropriate referrals, monitor progress and take ongoing actions. Decide if time-loss compensation is payable, establish initial rate of compensation and if necessary, issue a wage order. Respond to liens or other reductions in time-loss compensation benefits according to statute. Resolve and communicate decisions made in response to protests. Address board and court orders and applications to reopen claims. Compose medical examination assignments and investigation assignments, legal orders, and letters. Provide direct customer service. Respond to inquiries regarding claim information, the department's rules and regulations, and the claim adjudication process. Prepare a variety of claim file correspondence such as letters, legal orders, and secured messages. Compose investigation assignments. Mentor lower-level adjudicators, and new level 3 adjudicators to use independent judgement to manage claims using RCWs, WACs, policies, case law and department resources.

Qualifications Required: Successful completion of the Department of Labor and Industries Workers' Compensation Adjudicator 2 Apprenticeship program. ANDSix months of experience as a Workers' Compensation Adjudicator 2 by January 16, 2027. OR Bachelor's degreeANDTwo years of experience in adjudicating workers' or crime victims' compensation insurance claims, or adjudication of time loss payments. OR Equivalent education/experience.**Additional experience working with insurance claims, claims/insurance adjusting, claims investigations, disability management, claims risk management/loss control, medical billing, medical insurance, paralegal personal injury services or paramedical occupations will substitute, year for year, for required education.

Required Equity Competencies: The ability to take action to learn and grow. The ability to take action to meet the needs of others. Desired: •Journey level WCA 2s and/or WCA 3's who have excelled in their current jobs, can work well with the team and get up to speed quickly. •Advanced ability to research, analyze facts, mathematical calculations, and apply rules and regulations contained in federal law, state law and department procedures. •Motivated self-starters who take initiative and who continually develop and upgrade their knowledge, skills, and abilities. •Write clear, concise, accurate, and informative correspondence and reports. •Proficient use of Microsoft office, web browsers, and other applications. Use dual monitors to access and move between multiple programs. •Demonstrated analytical thinking and decision-making skills and abilities. •Individuals who can create and sustain a Customer Centered team and work environment; cooperative, courteous and responsive in all interactions. •Organized, effectively prioritize and perform multiple tasks. •Meet productivity standards, deadlines and work schedules; working to be efficient in the use of resources, work time and equipment. •Professional, prompt, dependable, always maintaining the highest levels of confidentiality and professionalism. Supplemental Information Things You Need To Know To help you maintain a proper work-life balance, teleworking is one of the work schedule options for this position. L&I also offers flexible custom work schedules. 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. At L&I, your voice matters. In addition, L&I is a diverse state agency dedicated to the safety and health and security of Washington's 3.3 million workers. Take a look at this brief video and learn more about why L&I is an employer of choice. For this position, telework is dependent upon business needs and supervisor approval. The assigned duty station for this position is Tumwater, Washington. For positions where in-office work is necessary, the frequency of telework will be discussed with the supervisor of the position at the time of offer. To receive more information on opportunities at L&I sign up for GovDelivery and select L&I job alerts.

Application process: We will contact the top candidates directly to interview for this position. Because we base the selection on information provided by you, it is in your best interest to identify the knowledge, skills, and abilities that address the required and desirable qualifications described in the announcement. Please include the following documents with your application: A cover letter describing specific qualifications. A current resume detailing applicable experience and education. A list of at least three professional references with current telephone numbers. Please do not attach or place any medical information (vaccination status included) within the application, resume, or cover letter. If you do, we will have to reject your application to safeguard others from receiving your confidential information. You will have to remove the confidential information before you can apply again. To learn more about our hiring process timeline at L&I please visit our L&I recruiting page at Hiring Process at L&I. If you would like to read our website in a language other than English, scroll up to the top of the page to select your language of choice from the banner. Background Check Notice Prior to a placement in this position, a background check, including criminal history record will be conducted. Information from your background check will not necessarily preclude employment but will be considered in determining your eligibility to perform the requirements of the position.

Other information: A job offer is contingent upon completion of a background check that includes a criminal record review. For positions requiring travel, you must have a valid unrestricted driver's license and have insurance if driving a privately owned vehicle on state business. We do not use translating software. This position is represented by the Washington Federation of State Employees (WFSE).Candidates who are offered a job with L&I must possess work authorization that does not require sponsorship by the employer for a visa now or in the future. When hired as bilingual, our top applicant will be required to pass an assessment of the ability to write and speak Spanish fluently. We do not use translating software. Employees with bilingual responsibilities receive a 5% increase in pay. The Department of Labor & Industries complies with the employment eligibility verification requirements of the federal employment eligibility verification form, I-9. The selected candidate must be able to provide proof of identity and eligibility to work in the United States consistent with the requirements of that form on the first day of employment.

Please note: L&I may use this announcement to fill multiple permanent and/or non-permanent positions. Did You Know? Washington is America's Top State to live, play, and work, according to U.S. News (2021). Join the L&I team and enjoy all the Evergreen State has to offer. In addition to offering a positive balance between life and work, L&I provides one of the most competitive benefits packages in the nation. We also believe your voice matters. We value our employees and their work-life balance by encouraging flexible schedules. L&I is a diverse state agency dedicated to the safety and health and security of Washington's 3 million workers. Veterans Preference Applicants wishing to claim Veterans Preference should attach to their application a copy of their DD-214 (Member 4 copy), NGB 22, or signed verification of service letter from the United States Department of Veterans Affairs. Please blackout any personally identifiable data such as Social Security numbers. For further information, contact L&I's Jobs@lni.wa.gov. Diversity, Equity, and Inclusion Employer L&I employees come from all walks of life. We strive to hire great people from a wide variety of backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. We believe in the importance of recognizing the value each of us contributes to the success of the agency mission. Having a diverse workforce is this agency's greatest source of strength and knowledge. It is through the combination of talents and abilities that we can pursue finding effective measures to provide the best customer service. We are committed to building a diverse and inclusive workplace for everyone and we strongly mean everyone. The State of Washington is an equal opportunity employer. Persons with a disability who need accommodation in the application process or testing process, or those needing this announcement in an alternative format, may call 360-902-5700. TTY users should first call 711 to access the Washington Relay Service. You are welcome to include the name and pronoun you would like to be referred to in your materials, and we will honor this as you interact with our award-winning diverse and inclusive organization. For more Information If you have any questions regarding this job posting, program, or the agency, please contact Elena Emery at Jobs@lni.wa.gov .#LI-DNIBenefitsMore than Just a Paycheck! Employee benefits are not just about the kind of services you get, they are also about how much you may have to pay out of pocket. Washington State offers one of the most competitive benefits packages in the nation. We understand that your life revolves around more than just your career. Like everyone, your first priority is ensuring that you and your family will maintain health and financial security. That's why choice is a key component of our benefits package. We have a selection of health and retirement plans, paid leave, staff training and other compensation benefits that you can mix and match to meet your current and future needs. Read about our benefits: The following information describes typical benefits available for full-time employees who are expected to work more than six months. Actual benefits may vary by appointment type or be prorated for other than full-time work (e.g. part-time); view the job posting for benefits details for job types other than full-time.

Note: If the position offers benefits which differ from the following, the job posting should include the specific benefits. Insurance Benefits Employees and their families are covered by medical (including vision), dental and basic life insurance. There are multiple medical plans with affordable monthly premiums that offer coverage throughout the state. Staff are eligible to enroll each year in a medical flexible spending account which enables them to use tax-deferred dollars toward their health care expenses. Employees are also covered by basic life and long-term disability insurance, with the option to purchase additional coverage amounts. To view premium rates, coverage choice in your area and how to enroll, please visit the Public Employees Benefits Board (PEBB) website. The Washington Wellness program from the Health Care Authority works with PEBB to support our workplace wellness programs. Dependent care assistance allows the employee to save pre-tax dollars for a child or elder care expenses. Other insurance coverage for auto, boat, home, and renter insurance is available through payroll deduction. The Washington State Employee Assistance Program promotes the health and well-being of employees. Retirement and Deferred Compensation State Employees are members of the Washington Public Employees' Retirement System (PERS). New employees have the option of two employer contributed retirement programs. For additional information, check out the Department of Retirement Systems ' web site. Employees also have the ability to participate in the Deferred Compensation Program (DCP). This is a supplemental retirement savings program (similar to an IRA) that allows you control over the amount of pre-tax salary dollars you defer as well as the flexibility to choose between multiple investment options. Social Security All state employees are covered by the federal Social Security and Medicare systems. The state and the employee pay an equal amount into the system. Public Service Loan Forgiveness If you are employed by a government or not-for-profit organization, and meet the qualifying criteria, you may be eligible to receive student loan forgiveness under the Public Service Loan Forgiveness Program. Holidays Full-time and part-time employees are entitled to paid holidays and one paid personal holiday per calendar year.

Note: Employees who are members of certain Unions may be entitled to additional personal leave day(s), please refer to position specific Collective Bargaining Agreements for more information. Full-time employees who work full monthly schedules qualify for holiday compensation if they are employed before the holiday and are in pay status for at least 80 nonovertime hours during the month of the holiday; or for the entire work shift preceding the holiday. Part-time employees who are in pay status during the month of the holiday qualify for the holiday on a pro-rata basis. Compensation for holidays (including personal holiday) will be proportionate to the number of hours in pay status in the month to that required for full-time employment, excluding all holiday hours. Pay status includes hours worked and time on paid leave. Sick Leave Full-time employees earn eight hours of sick leave per month. Overtime eligible employees who are in pay status for less than 80 hours per month, earn a monthly proportionate to the number of hours in pay status, in the month to that required for full-time employment. Overtime exempt employees who are in pay status for less than 80 hours per month do not earn a monthly accrual of sick leave. Sick leave accruals for part-time employees will be proportionate to the number of hours in pay status, in the month to that required for full-time employment. Pay status includes hours worked, time on paid leave and paid holiday. Vacation (Annual Leave) Full-time employees accrue vacation leave at the rates specified in WAC 357-31-165 (1) or the applicable collective bargaining agreement (CBA). Full-time employees who are in pay status for less than 80 nonovertime hours in a month do not earn a monthly accrual of vacation leave. Part-time employees accrue vacation leave hours in accordance with WAC 357-31-165 (1) or the applicable collective bargaining agreement (CBA) on a pro rata basis. Vacation leave accrual will be proportionate to the number of hours in pay status, in the month to that required for full-time employment. Pay status includes hours worked, time on paid leave and paid holiday. As provided in WAC 357-58-175, an employer may authorize a lump-sum accrual of vacation leave or accelerate the vacation leave accrual rate to support the recruitment and/or retention of a candidate or employee for a Washington Management Service position. Vacation leave accrual rates may only be accelerated using the rates established WAC 357-31-165.

Note: Most agencies follow the civil service rules covering leave and holidays for exempt employees even though there is no requirement for them to do so. However, agencies are required to adhere to the applicable RCWs pertaining holidays and leave. Military Leave Washington State supports members of the armed forces with 21 days paid military leave per year. Bereavement Leave Most employees whose family member or household member dies, or for loss of pregnancy, are entitled to five (5) days of paid bereavement leave. In addition, the employer may approve other available leave types for the purpose of bereavement leave. Additional Leave Leave Sharing Parental Leave Family and Medical Leave Act (FMLA) Leave Without Pay Please visit the State HR Website for more detailed information regarding benefits. Updated 01-07-2026