L&I Workers' Compensation Adjudicator 3/Claim Manager

State of Washington; Tumwater (WA); Remote; USD 85,000 - 125,000; Full time

Job summary

Department of Labor & Industries in Tumwater seeks a Workers’ Compensation Adjudicator 3/Claim Manager to independently manage a caseload of State Fund claims, ensuring timely medical and wage replacement benefits. The role involves interpreting law, referrals for vocational services, and handling complex adjudication decisions.

Eligible candidates include internal L&I applicants; a WCA2 Apprenticeship, Bachelor's degree, or equivalent education/experience qualifies.

Qualifications

• Successful completion of the Department of Labor & Industries WCA 2 Apprenticeship program.
• Six months of experience as a Workers’ Compensation Adjudicator 2 by January 16, 2027.
• Bachelor's degree is required OR equivalent education/experience.
• Two years of experience adjudicating workers’ or crime victims’ compensation claims, or adjudication of time loss payments.

Responsibilities

• Manage a caseload; review and adjudicate industrial insurance claims per laws and case law.
• Interpret facts and apply the law to determine claim validity and adjudicative actions within timelines.
• Decide time‑loss compensation eligibility and issue wage orders when applicable.
• Respond to protests, enforce board/court orders, and prepare legal orders and correspondence.
• Provide direct customer service and respond to inquiries about claims and rules.

Skills

Legal interpretation

Case management

Research & analysis

Education

Bachelor's degree

Two years of adjudicating workers’ or crime victims’ compensation claims

Job description

Our Mission

Keep Washington Safe and Working!

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.

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.

Required

• Successful completion of the Department of Labor and Industries Workers’ Compensation Adjudicator 2 Apprenticeship program.
• AND Six months of experience as a Workers’ Compensation Adjudicator 2 by January 16, 2027.
• OR Bachelor's degree
• AND Two 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.

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. State employees who meet the qualifications will become eligible for a generous retirement package at the end of the employee’s career.

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.

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.

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

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

[e-mail].