We are currently assisting our client with a search for a Workers Compensation Claims Manager II.

JOB SUMMARY:

The claims manager will work as part of a team that manages workers’ compensation. The position involves effective, proactive claims management in addition to communicating with employers, medical providers and Washington State Department of Labor and Industries, as well as other stakeholders.

Core Duties and Responsibilities (include but are not limited to):

• Proactively manage a claims caseload, moving claims to timely resolution; review and adjudicate industrial insurance claims in accordance with industrial insurance and case law. All claim information will be utilized within our software system. Claims may or may not be for employers enrolled in Retrospective Rating.
• Develop action plans for each claim, including tracking and formalizing written light- duty/return-to-work offers. Proactively communicates with employers throughout the process. Addresses and documents potential red flags when warranted.
• Evaluates appropriateness of vocational services, makes referrals, monitors progress and takes ongoing actions as required. Corresponds with medical specialists, employers, state adjudicators, and vocational counselors to compile information and documentation.
• Resolves and communicates decisions made in response to protests. Addresses board and court orders and applications to reopen claims. Compose medical examination assignments and investigation assignments, legal orders, and letters.
• Provides direct customer service including phone and written inquires. Responds to inquiries regarding claim information, the department’s rules and regulations, and the claim adjudication process.
• Creates action plans and claim reviews for employers and proactively reaches out to keep the employer informed. Participates in meetings with employers to discuss either EMR or Retro performance and goals.
• Educates employers about KOS, RTW and L&I’s Stay at Work (SAW) wage reimbursement program. May assist the employer in obtaining SAW reimbursements and submit timely SAW reimbursement requests.
• Educates employers about retrospective rating programs and requirements.
• Utilizes virtual platforms when onboarding new contacts or employer meetings.
• Continually audits assigned claims to verify L&I determinations have been made in accordance with state regulations, and that all relevant and proper documentation is contained in the state insurance file.
• Calculates and verifies benefit payments for accuracy and eligibility as well as providing proof of Kept on Salary, (KOS).
• Other duties, responsibilities, and activities may change or be assigned at any time with or without notice.

EDUCATION AND EXPERIENCE:

• Required: High school diploma or equivalent
• Required: Three or more years of customer service experience
• Required: Four or more years managing time loss claims
• Preferred: One or more years of experience with a retrospective rating program

TECHNICAL SKILLS:

• Required: Excellent MS Office Suite experience, particularly Outlook, Word, Excel, Teams
• Preferred: Experience with claims management systems, SharePoint, and current office automation tools

KEY SKILLS FOR THIS ROLE:

• Ability to prioritize with accuracy in a fast-paced environment.
• Ability to follow department practices and procedures and make suggestions for improvement.
• Ability to recognize evolving trends involving Labor & Industries, claim frequency and safety issues with employers.
• Ability to provide high-quality, accurate and timely service to members.
• Ability to customize service needs for individual employers.
• Excellent written and verbal communication skills for both internal and external audiences.
• Proficiency working independently and as part of a team.
• Openness to organization change, continuous improvement, and a willingness to learn new skills.
• Participate in creating and working on quarterly objectives, working with managers and teams.

Core Duties and Responsibilities (include but are not limited to):

• Proactively manage a claims caseload, moving claims to timely resolution; review and adjudicate industrial insurance claims in accordance with industrial insurance and case law. All claim information will be utilized within our software system. Claims may or may not be for employers enrolled in Retrospective Rating.
• Develop action plans for each claim, including tracking and formalizing written light- duty/return-to-work offers. Proactively communicates with employers throughout the process. Addresses and documents potential red flags when warranted.
• Evaluates appropriateness of vocational services, makes referrals, monitors progress and takes ongoing actions as required. Corresponds with medical specialists, employers, state adjudicators, and vocational counselors to compile information and documentation.
• Resolves and communicates decisions made in response to protests. Addresses board and court orders and applications to reopen claims. Compose medical examination assignments and investigation assignments, legal orders, and letters.
• Provides direct customer service including phone and written inquires. Responds to inquiries regarding claim information, the department’s rules and regulations, and the claim adjudication process.
• Creates action plans and claim reviews for employers and proactively reaches out to keep the employer informed. Participates in meetings with employers to discuss either EMR or Retro performance and goals.
• Educates employers about KOS, RTW and L&I’s Stay at Work (SAW) wage reimbursement program. May assist the employer in obtaining SAW reimbursements and submit timely SAW reimbursement requests.
• Educates employers about retrospective rating programs and requirements.
• Utilizes virtual platforms when onboarding new contacts or employer meetings.
• Continually audits assigned claims to verify L&I determinations have been made in accordance with state regulations, and that all relevant and proper documentation is contained in the state insurance file.
• Calculates and verifies benefit payments for accuracy and eligibility as well as providing proof of Kept on Salary, (KOS).
• Other duties, responsibilities, and activities may change or be assigned at any time with or without notice