The Washington State Hospital Association (WSHA) is seeking a full-time dynamic, dedicated, and professional Time Loss Adjudicator to join our team!
WSHA has been in existence for over 80 years and is the trusted voice and indispensable resource that leads, challenges and assists Washington hospitals and health systems to improve the health of the communities they serve. We are a strong advocate for and provide value to our members in achieving their missions by committing the following:
- We are a member-led association committed to providing servant leadership.
- We are honest in our work and operate with transparency and accountability.
- We act cooperatively, incorporate diverse perspectives, and use the power of the collective to achieve our mission.
- We are agile and drive continuous quality improvement.
We are in beautiful downtown Seattle, surrounded by wonderful views of Puget Sound and the Olympic mountains, with easy access to bus lines or underground parking.
For more information about WSHA, visit us at www.wsha.org.
WSHA is looking to add a committed and supportive Time Loss Adjudicator to adjudicate and manage Washington State self-insured time-loss and treatment-only workers’ compensation claims for our two group self-insured employers, Public Hospital District Workers’ Compensation Group and Washington Hospitals Workers’ Compensation Group as well as individual self-insured employers. This includes regulating of self-insured workers’ compensation claims for compliance with the Industrial Insurance Laws Title 51 (RCW), Medical Aid Rules and other statutes related to industrial insurance. This position requires the ability to interact with diverse groups and maintain confidentiality and a high level of discretion.
Core Duties and Responsibilities:
Adjudicates workers’ compensation claims to interpret facts and apply laws in determination of claim validity and is responsible for timely and efficient case management. Establishes rate of compensation and makes timely payments for time loss claims.
Completes the 3-point contact within 48 hours of receipt of Notice of Claim for new claims and at the time of each monthly formal file review.
Establishes initial case reserves on time loss (TL) claims (TO claims $1500) and periodically reviews case reserving according to medical and legal documentation received on case files.
Establishes a written Plan of Action (POA) before supervisor’s first-pay file review. Continue to insert Action Plans every 60 – 90 days on TL claims, and every 90 – 120 days on MO claims.
Ensure all necessary elements are in place so initial disability payments are made within 14 days from date. Deliver claim file to supervisor after initial payment is made.
Determines need for vocational services; approves or denies formal plans on vocational services.
Investigates and pursues Third Party subrogation claims.
Approves medical payments on claim files on a weekly basis.
Monitors early return-to-work opportunities and coordinates job accommodation.
Prepares claims for closure with the Department of Labor & Industries and forwards to the Supervisor of Claims Services for review.
Complete claim updates and reviews on-site, by telephone or by webcam with designated hospital personnel on a quarterly basis. Onsite visits with members required on a rotating basis. Over-night travel may be required.
Works with Unemployment Program and Safety staff on joint accounts to coordinate documentation in an effort to discover fraudulent concurrent claims and reduce costs.
Work with Designated Hospital Contacts answering questions, educating and updating them on an ongoing basis with regard to their assigned duties.
Communicates both verbally, and in writing, to maintain a professional and diplomatic relationship with all Department of Labor & Industries personnel, designated hospital contacts, physicians, injured workers, claimant attorneys, and other related parties that interface with industrial insurance and with Claims staff members.
Secures services, supervises and monitors independent physicians, vocational counselors, nurse case managers, defense counselors, and investigators.
Maintains a current claims diary, defined per the performance standards.
Reviews claim files and medical reports per diary date to evaluate need for ongoing disability certification, and authorize or deny requests for medical treatment, surgery, diagnostic studies, and transfer of physician.
Reviews determinative orders by Department of Labor & Industries for appropriate decision regarding entitlement of benefits. Makes timely protests as warranted.
Evaluates medical reports to determine appropriate permanent partial disability awards.
Attends and represents Washington Hospitals Workers’ Compensation Program at self-insured meetings, seminars and other meetings as designated.
Maintains current position certification(s) (e.g. those required by Department of Labor and Industries).
Education/Experience: Bachelor’s Degree in Business/Marketing (or related field); or a minimum of 3 years of recent Workers’ Compensation experience processing both Time-loss and Treatment-only claims; or equivalent combination of education and experience.
Skills & Abilities: Demonstrated customer service and interpersonal skills. Must be a self-starter and innovator. Ability to work independently. Must possess strong analytical and organizational skills. Must be reliable with a strong attendance record.
Computer Skills: Strong computer skills with knowledge of MS Office applications including database and web based systems. Proficiency in using Zoom, MS Office Suite (Word, PowerPoint, Excel, Outlook, TEAMs).
Certificates and Licenses: Must have a valid Washington State Claim Administration certification and/or obtain certification pursuant to Department of Labor and Industries regulations and eligibility requirements after obtaining employment at Washington Hospital Services. Must have a valid unrestricted Washington State Drivers’ License and proof of insurance.
Familiarity with RCW 51 and WAC 296.
Experience with computerized claims processing.
Department of Labor and Industries Claims Certification.
Experience working in administration in a healthcare setting.
KNOWLEDGE, SKILLS, ABILITITES:
- Thorough knowledge of workers compensation claims duties and responsibilities.
- Ability to gather information and prepare written material or presentations.
- Ability to communicate and interact with people from diverse backgrounds in a sensitive and positive manner.
- Knowledge of WSHA workflows, policies and procedures.
- Ability to prioritize job assignments.
- Ability to deal simultaneously with several issues or problems.
- Ability to communicate professionally and effectively both orally and in writing.
- Ability to provide quality customer service.
- Ability to work collaboratively with colleagues, co-workers and members.
Salary and Benefits:
WSHA offers a competitive base salary plus benefits and generous paid leave, among many other benefits.
If you are interested in this position, please apply through our career center at https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=e90b930c-785e-43d7-a956-3b6091cf3463&ccId=19000101_000001&lang=en_US&jobId=9200139193451_1&source=EN
WSHA is an equal opportunity employer.