L&I Workers' Compensation Adjudicator 3/Claim Manager

Washington State Health Care Authority; Tumwater (WA); Remote; USD 80,000 - 105,000; Full time

Job summary

The Washington State Department of Labor & Industries seeks a Workers’ Compensation Adjudicator 3/Claim Manager to independently manage a high-complexity caseload of industrial insurance claims. The role supports timely, accurate medical and wage replacement benefits for injured workers.

Responsibilities include evaluating claims under RCWs and WACs, mentoring junior staff, and providing direct customer service while maintaining confidentiality and professionalism.

Qualifications

• Successful completion of the WCA 2 Apprenticeship program.
• Six months of experience as a Workers’ Compensation Adjudicator 2 by January 16, 2027.
• Bachelor’s degree or equivalent education/experience.
• Experience with insurance claims adjudication or related fields preferred.

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 actions.
• Decide time-loss eligibility and issue wage orders when needed.
• Respond to protests, board/court orders, and reopenings; communicate decisions.
• Provide direct customer service and respond to inquiries about claims and rules.
• Prepare claim file correspondence and investigation assignments.
• Mentor lower-level adjudicators to use independent judgment.
• Work with RCWs, WACs, and department procedures.

Skills

Mentoring

Research & analysis

Regulations understanding

Customer service

Education

WCA Apprenticeship

Bachelor’s degree

Tools

Microsoft Office

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.

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 Tum