Director of Workers' Compensation

Job Summary

The job of Director is done for the purpose of supervising the claims administration services of the Workers’ Compensation Insurance Cooperative, evaluating eligibility and processing workers’ compensation claims in compliance with WTC, state, and federal regulations, and serving as a liaison between member districts, injured workers, service providers, and government agencies.

Minimum Qualifications:

1. Five years’ experience in insurance industry, preferably in claims management.
2. Bachelor’s Degree, or additional years of experience in workers’ compensation claims may be substituted.
3. Washington State Dept. of L & I Self Insurance Department Approved Claims Adjustor or ability to get certified.
4. Valid Washington state driver’s license.

Preferred Qualifications and Skills:

1. Experience in program and budget development, identifying program and customer needs, defining solutions, and developing and implementing procedures.
2. Two years supervisory experience.
3. Current knowledge of case law, legislation, and general developments related to self-insurance.
4. Experience using workers' compensation claims specific database software.
5. Familiar with CPT and diagnostic codes for the State of Washington.
6. Experience using medical terminology to read and understand medical documents.
7. Experience using word processing, spreadsheet, and database programs in a Windows environment.
8. Current Washington State "Self Insurance Department Approved Claims Administrator" certification.
9. A claims-related national insurance industry designation (AIC, CPCU, etc.).
10. Thorough knowledge of RTW policies and processes.
11. Must have good human relations and interpersonal skills, demonstrated ability to keep confidentiality and show initiative when appropriate.

Essential Job Functions

1. Adjudicates workers’ compensation and related benefit claims (e.g. completing investigations, determining validity, setting reserves, calculating compensation amount, determining medical aid benefits; reaching closure, etc.) for the purpose of complying with legal requirements, cooperative agreements, and state/federal statutes.
2. Administers provision of workers' compensation benefits (e.g. high risk occupations, trends, early return- to-work program, etc.) for the purpose of ensuring services are appropriately provided, costs are at a reasonable level, and employees are returned to productive work activity as soon as possible.
3. Analyzes statistical summaries and reports (e.g. costs totals, body part affected, time loss, etc.) for the purpose of evaluating program effectiveness and developing process improvements.
4. Attends legal hearings on workers' compensation and related district benefit disputes for the purpose of representing the WCT and/or providing testimony.
5. Attends and/or develops a variety of meetings at the ESD, regional and state level (e.g. trust member trainings, workers' compensation coalition, loss reduction, etc.) for the purpose of conveying and/or gathering information required to perform job functions. Designs procedures for services provided by the department for the purpose of ensuring the services are effective and efficient in providing support to the Cooperative's workers' compensation administration operations. Supervises assigned WCT Claims Adjudicators (e.g. assigning work, completing performance evaluations, serve as a technical consultant to complex cases, etc.) for the purpose of guiding and monitoring their activities. Directs meetings with cooperative school districts and service providers (e.g. insurance carriers, vocation counselors, clinics, etc.) for the purpose of enhancing relationships, ensuring negotiated services are appropriate and cost effective. Maintains and supervises workers' compensation files and records for the purpose of documenting actions and ensuring compliance with federal, state, and district rules and legal requirements. Prepares a wide variety of written materials (e.g. reports, analyses, recommendations, procedures, etc.) for the purpose of providing written reference, conveying information and/or supporting presentations concerning policy and procedure changes. Provides technical expertise for complex workers' compensation cases (e.g. initiate settlements, draft settlement language, and negotiate and approve settlements to authority level, establish legal management parameters, evaluate loss exposure, develop resolution strategies, refer cases to legal counsel for analysis, etc.) for the purpose of developing plans and/or resolving issues. Researches a wide variety of regulatory issues for the purpose of ensuring WCT practices are in compliance with local, state and/or federal laws and regulations. Responds to questions from district and non-district personnel in regards to workers' compensation and other employee benefits for the purpose of conveying information. Uphold and assist in enforcing administrative regulations and board policy. Take all necessary and reasonable precautions to protect children, equipment, materials and facilities. Requires the use of multiple communication and technology systems, which may include electronic mail, computers, document cameras, smart boards and web-based resources. Job presence. Cooperation with management team members. Uphold and assist in enforcing administrative regulations and board policy. Take all necessary and reasonable precautions to protect children, staff, equipment, materials, and facilities. Requires the use of multiple communication and technology systems, which may include electronic mail, computers, document cameras, smart boards, and web-based resources.

Other Job Functions:

1. Assist OESD organization with risk management and safety/security for the organization.
2. Assist OESD with Unemployment cooperative.
3. Other duties as assigned.