Job Details

Claims Team Lead

This recruitment is open to King County employees only. The Central Employee Services Division within King County's Department of Human Resources (DHR) seeks a seasoned Workers' Compensation Claims expert to fill a key role in the day-to-day operations of the Safety and Claims Section. Reporting to the Claims Officer Supervisor, the Claims Team Lead will be the technical expert in claims management and will manage the more complex cases within the unit. The successful candidate will be responsible for database and claims management, staff and project development, and serve as lead for the Claims Officers. This role requires outstanding interpersonal, team building, and communication skills: and a deep knowledge of and experience with the professional and regulatory workers' compensation environment in Washington state.

Applying equity and social justice principles (ESJ) is a daily responsibility and a foundational expectation for all King County employees. This role will champion King County's deep commitment to ESJ by exemplifying shared values, behaviors, and practices in all aspects of the work.

• Serve as a technical expert and team lead within the unit. Provide leadership, technical assistance, and training to staff and partners on best practices in claims management.
• Perform general audit functions of claims in iComp (Claims Processing system) for quality assurance and continuously monitor the quality and efficiency of the claims adjudication process.
• Assist the Claims Officer Supervisor with policy recommendations and creating standard operating procedures for the claims adjudication processes.
• Assist the Claims Officer Supervisor with the development and facilitation of training and education of King County supervisors and employees on workers' compensation policies and processes, through written materials and presentations.
• Assist Claims Officer Supervisor in coordinating, monitoring, and tracking analytical and statistical information related to workers' compensation and the production of relevant reports and recommendations.
• Manage all data gathering for performance reviews of Claims Officers, conduct claim reviews and audits, and review penalties. Provide performance evaluation input for program staff to Claims Officer Supervisor.
• Propose scope of work and goals for ad hoc assignments or projects for Claims Team. Perform data collection and conduct analyses for assigned research projects; prepare summary reports of analyses and presentation of findings.
• Provide, lead or conduct required analyses, including compliance with all relevant laws and regulations that affect workers' compensation administration. Evaluate new regulations, laws and legislation for impact on services and program goals. Develop and/or modify existing processes for new regulations, laws and legislation with Claims Officer Supervisor.
• Manage a limited caseload of complex workers' compensation claims to closure or settlement. Claims Team Lead will have limited claim settlement authority to resolve claims.
• Onboard and train newly hired Claims Officers to the unit in partnership with the Claims Officer Supervisor.
• Resolve concerns and issues from injured workers, attorney representatives, regulators and other partners that interact with the workers compensation program.
• Serve as a subject matter expert on third party issues, payroll systems, and time loss calculations and processing.
• Other duties as assigned.

Minimum Qualifications:

• Six years of experience managing and processing industrial claims with disability benefits, including vocational rehabilitation OR any equivalent combination of experience and education which provides the applicant with the desired skills, knowledge, and ability required to perform the work.
• A minimum of one (1) year experience in adjudicating Washington State Workers' Compensation claims
• Claims Administration Certification by the Washington State Department of Labor and Industries OR Washington Workers' Compensation Professional certification

Other Qualifications:

• Experience in directing the work of others with the ability to lead, mentor, and coach staff members to work cooperatively and effectively.
• Possess strong negotiation and communication skills. Be able to manage diverse and potentially conflicting perspectives and backgrounds.
• Experience developing and presenting training information, using handouts, materials, visual aids, and other tools for group and one-on-one instruction in person or via online platforms.
• Experience with database management and creating reports; coordinating, monitoring, and tracking analytical and statistical information.
• Knowledge of state laws, regulations, and relevant court rulings regarding workers' compensation; knowledge of standard medical and legal terminology, practices, and procedures; knowledge of investigation and adjudication practices of industrial insurance claims.
• Ability to calculate claims related figures quickly and accurately.
• Excellent oral and written communication skills, and the ability to communicate with diverse individuals at all levels, both internally and externally.
• Demonstrated problem-solving and analytical skills with the ability to manage multiple and shifting priorities to meet deadlines, while working under pressure and considering broad impacts to meet customer service expectations and regulatory deadlines.
• Demonstrated commitment to deliver courteous, sensitive, and responsive service to all internal and external customers with the ability to act with the utmost integrity in all professional interactions.
• Intermediate level proficiency with Microsoft Office Suite and data management software and demonstrated ability to quickly learn new technology tools.
• Experience and demonstrated ability to work effectively and collaboratively with individuals from diverse backgrounds, including sensitivity to and knowledge of various ethnic, cultural, and socioeconomic backgrounds.

Desirable Qualifications:

• Experience working with Washington State Self Insured employers for the purpose of workers compensation.

Other Position Information:

This position is exempt from the provisions of the Fair Labor Standards Act and is not overtime-eligible. Employees are paid on a bi-weekly schedule, every other Thursday, comprising a 40-hour workweek, normally 8:00 a.m.-5:00 p.m., Monday through Friday. This position is represented by Teamsters Local 117/Professional & Technical and is classified as Project/ Program Manager III (job code 243304). Teleworking Requirement This position works a hybrid schedule of remote and onsite work, requiring work in the office at least three days a week. Hybrid work schedules are subject to change based upon operational necessity. Employees must reside in Washington state and within a reasonable distance to their King County worksite to respond to workplace reporting requirements. King County has a robust collection of tools and resources to support working remotely. Employees will be provided with a County-issued laptop and must maintain a homework space with an internet connection where they can reliably perform work and remain available and responsive during scheduled work hours.