Workers' Compensation - Pandemic Impact Claims Analyst

The Seattle Department of Human Resources (SHR) endeavors to promote an equitable and engaging work environment so City of Seattle employees can do their best work and make a difference for the people and communities we serve. SHR focuses on providing high quality services to all City employees and departments and works collaboratively with department leaders to align policies, practices, and programs citywide to fulfill the vision of equity and excellence.
Within the department, the Workers' Compensation unit delivers customer service and proactive claims management to City employees. This unit is responsible for administering the City's self-insured and self-administered Workers' Compensation program with a human centered focus. The unit has seen a large increase in claims due to the COVID-19 pandemic. We are looking for a compassionate and capable Worker's Compensation Analyst to adjudicate and effectively manage these COVID-19 impacted claims, many of which were drastically impacted by lengthy delays in conservative treatment and non-urgent surgical interventions.

Here's more about what you'll be doing:

• Obtaining and evaluating current medical reports and treatment notes for ongoing eligibility of medical and indemnity benefits
• Calculating and assigning timely and appropriate reserves to claims
• Managing reserve adequacy through the life of the claim based on ultimate probable outcome
• As needed, performing systematic review of ongoing COVID claim management and may serve as a unit subject matter expert
• Hiring, directing, and monitoring independent professional consultants to assist in resolving medical or vocational issues
• Systematically reviewing for appropriateness of new vocational referrals on claims in which time loss benefits are ongoing/longstanding and in which no prior vocational referral has been made, intervening and redirecting treatment or vocational plans where necessary
• Facilitating and coordinating legal return to work programs with the employing department
• Evaluating and monitoring injured worker progress to determine whether treatment is appropriate, and to ensure that the employee is complying with treatment recommendations and/or vocational plans
• Submitting requests for suspension or termination of benefits as necessary
• Evaluating medical and legal information to determine when the claim can be closed
• Obtaining an independent medical examination to establish the degree of permanent impairment, if any, or to resolve disputed closure issues
• Identifying, initiating, and managing third party action on claims involving subrogation and responding to third party inquiries, coordinating with unit leadership regarding settlement and negotiation requests
• May prepare summaries of claims under appeal for referral to the City Attorney's Office, respond to interrogatories, and testify on specific issues and claims management decisions at the Board of Industrial Insurance Appeals and/or grievance and discrimination hearings

You will be successful in this role if you have a passion for:

• Delivering customer-focused service to all claim parties to achieve positive outcomes
• Acting in a fair and equitable manner with employees throughout an organization
• Successfully resolving open claims of varied complexities

Your effectiveness in this role will depend on your ability to:

• Maintain claims management organizational practices, file coding, case management, and record keeping
• Be self-motivated while utilizing sound judgement and independent decision-making in your claims management
• Communicate with a wide variety of people and perspectives, including in situations that require confidently upholding your decision-making
• Manage multiple priorities quickly while ensuring deadlines are satisfactorily met

You will be prepared for this role if you have experience or certification in:

• Washington State Workers' Compensation claims handling and management, including pertinent guidelines, laws, and rules
• Adjudicating workers compensation claims through developed action plans, managing timely reserve adequacy throughout the life of the claim
• Reading and interpreting medical terminology and the Washington Labor and Industries Medical Treatment Guidelines
• Calculating and paying timely benefits as owed, approving timely claim payments and adjustments
• Washington Workers' Compensation Professional designation (WWCP) preferred

In addition to the ability to perform the tasks described above, you will need to possess the below required qualifications:

• A Bachelor's Degree in general education, paralegal studies, law, social science, nursing, medical coding, business administration, or a related field
• One year directly reviewing, evaluating, investigating, and processing Washington Workers' Compensation, or a related field

OR

• An Associate Degree in general education, paralegal studies, law, social science, nursing, medical coding, business administration, or a related field
• Two years directly reviewing, evaluating, investigating, and processing Washington Workers' Compensation, or a related field

OR

Additionally, in accordance with WAC 296-15-350:

OR

This position is classified as a Workers' Compensation Analyst and reports to the Workers' Compensation Manager. The full pay range for this step-progression position is $40.08 - $46.68 per hour. New employees begin at Step 1 of the pay progression, which is $40.08 hourly. Current City employees starting rate of pay will be based on Personnel Rules regarding promotions.

This position is a contract-in position, which means that it has been approved for two years, at which point it will be evaluated for extension or expiration.

Interviews for this position are tentatively scheduled for Wednesday, June 7 and Thursday, June 8, 2023.

This position offers the flexibility of a hybrid work schedule. Employees will be expected to be in-office twice a week for a minimum of 4 hours per day. One of these days must be Monday, as the team has a collective in-office day on Monday mornings. Individual schedules will be based on agreement between the employee and their supervisor.

Applicants must successfully pass a background check, which will be conducted in accordance with Seattle's Fair Chance Employment Ordinance, SMC 14.17. Applicants will be given a chance to explain or correct background information and provide verifiable information of good conduct and rehabilitation.

Individuals selected to fill this position may be eligible to receive Language Premium Pay (SMC 4.20.360), which provides a $200.00 monthly stipend to qualified bilingual employees who are properly evaluated and assigned to provide direct communication in-language, interpretation, or translation services to the public on behalf of the City of Seattle.

The City of Seattle recognizes every City employee must play a role in ending institutional and structural racism. Our culture is the result of our behavior, our personal commitments, and the ways we courageously share our perspectives and encourage others to do the same. To cultivate an antiracist culture, we seek employees who will engage in the Race and Social Justice Initiative by working to dismantle racist policies and procedures, unlearn the way things have always been done, and provide equitable processes and services.

The City of Seattle offers a comprehensive benefits package including vacation, holiday, and sick leave as well as medical, dental, vision, life and long-term disability insurance for employees and their dependents. More information about employee benefits is available on the City's website at: https://www.seattle.gov/human-resources/benefits/employees-and-covered-family-members/most-employees-plans.

APPLICATION PROCESS:

To be considered for this position, please submit your complete application, resume, and cover letter to https://www.governmentjobs.com/careers/seattle no later than 4:00pm Pacific Time on Tuesday, May 23, 2023. This position is open to all candidates that meet the minimum qualifications. The City of Seattle values diverse perspectives and life experiences. Applicants will be considered regardless of race, color, creed, national origin, ancestry, sex, marital status, disability, religious or political affiliation, age, sexual orientation, medical condition, or pregnancy. The City of Seattle encourages people of all backgrounds to apply, including people of color, immigrants, refugees, women, LGBTQ, people with disabilities, veterans, and those with diverse life experiences. If you have questions, please contact Lindsey King at Lindsey.King@seattle.gov.

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Employment Type: Classified Civil Service, Term Limited, Full-Time