Claims Quality Auditor jobs in Lacey, WA

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Job link: https://ats4.atenterprise.powerschool.com/ats/job_board_form?op=view&JOB_ID=4600296437&COMPANY_ID=JA001160&redirect_qs=&redirect_qs=start_index=100&APPLICANT_TYPE_ID=00000002&COMPANY_ID=JA001160

Capital Region ESD 113 is committed to closing gaps, growing people, influencing change, and eradicating racism through our service to our region and state. BIPOC as well as culturally and linguistically diverse candidates are strongly encouraged to apply.

This position is 8 hours/day and 260 days/year. Benefits include Medical/Dental/Vision, Life/AD&D insurance, FSA/DCAP, LTD insurance, Retirement/DCP, EAP, Annual/Sick Leave and Holiday Pay.

Purpose Statement

The job of Claims Specialist is done for the purpose/s of evaluating eligibility of medical only claims and adjudicating workers' compensation claims in compliance with state RCW and WAC regulations; conveying information regarding medical claims and benefits; supporting loss control services in participating school districts; documenting actions; and providing program support and services consistent with internal practices and procedures.

This job is distinguished from similar jobs by the following characteristics: Per the essential functions and educational requirements listed below.

This job reports to Director - Risk Management or Claims Administrator

Essential Functions

• Adjudicates workers' compensation medical only claims (e.g. results of investigations, benefit eligibility, etc.) for the purpose of complying with state statutes, rules, policies, and internal procedures.
• Analyzes a variety of claims related information pertaining to eligibility of medical benefits and duration, and anticipated cost of benefits for the purpose of case reserving.
• Assesses workers' compensation claims activity for the purpose of identifying barriers to recovery and determining appropriate action for resolution in partnership with Workers' Compensation Claims Administrator or senior level Claims Adjudicators.
• Builds and maintains positive relationships with all member districts for the purpose of providing support to help grow the safety culture within the districts through a continued partnership, training tips, and various materials.
• Gathers data on various processes, procedures, and loss runs for the purpose of indentifying trends.
• Maintains workers' compensation claim files and records for the purpose of documenting actions and ensuring compliance with state statutes, rules, policies, and internal procedures.
• Regular and reliable attendance is required for the purpose of maintaining department operations.
• Responds to questions from district and medical providers for the purpose of facilitating communication among parties and providing information.
• Reviews medical only claims on a case-by-case basis for the purpose of identifying areas for safety and health improvements.
• Screens requests and coordinates the scheduling of a variety of activities for the purpose of providing services to help meet districts' needs.
• Travels off site for the purpose of supporting the needs of the program and participation in professional development training.

Marginal Functions

• Assists other personnel as may be required for the purpose of supporting the completion of work activities.
• Performs other related duties as assigned for the purpose of ensuring the efficient and effective functioning of work within the unit.

Job Requirements: Minimum Qualifications

Skills, Knowledge and Abililities

SKILLS are required to perform single, technical tasks with a need to occasionally upgrade skills in order to meet changing job conditions. Specific skill based competencies required to satisfactorily perform the functions of the job include: operating standard office equipment; using pertinent software applications; planning and managing case load and special projects; performing standard mathematical calculations; and preparing and maintaining accurate records.

KNOWLEDGE is required to perform basic math, including calculations using fractions, percents, and/or ratios; read a variety of manuals, write documents following prescribed formats, and/or present information to others; and understand complex, multi-step written and oral instructions. Specific knowledge based competencies required to satisfactorily perform the functions of the job include: worker compensation programs; state workers' compensation regulations and laws; medical and legal terminology related to worker's compensation; industrial insurance laws, medical aid rules and fee schedule; and basic anatomy and physiology.

ABILITY is required to schedule a number of activities, meetings, and/or events; often gather, collate, and/or classify data; and consider a variety of factors when using equipment. Flexibility is required to work with others in a wide variety of circumstances; analyze data utilizing defined but different processes; and operate equipment using a variety of processes. Ability is also required to work with a diversity of individuals and/or groups; work with data of varied types and/or purposes; and utilize a variety of types of job-related equipment. Problem solving is required to analyze issues and create action plans. Problem solving with data frequently requires independent interpretation of guidelines; and problem solving with equipment is moderate to significant. Specific ability based competencies required to satisfactorily perform the functions of the job include: communicating with diverse groups; working with frequent interruptions; working with detailed information/data; maintaining confidentiality; establishing effective relationships; adapting to changing work priorities; and thinking critically and executing processes efficiently.

Responsibility

Responsibilities include: working under limited supervision using standardized practices and/or methods; leading, guiding, and/or coordinating others; tracking budget expenditures. Utilization of resources from other work units may be required to perform the job's functions. There is some opportunity to impact the organization’s services.

Work Environment

The usual and customary methods of performing the job's functions require the following physical demands: occasional lifting, carrying, pushing, and/or pulling, some stooping, kneeling, crouching, and/or crawling and significant fine finger dexterity. Generally the job requires 70% sitting, 20% walking, and 10% standing. This job is performed in a generally clean and healthy environment.

Experience: Job related experience with increasing levels of responsibilities is required.

Education (Minimum): High school diploma or equivalent

Equivalency: None specified

Required Testing

None specified

Certificates and Licenses

Valid driver’s license & insurance coverage as required by law

WA State Self Insurance Certification at the time of hire or enrollment in a comprehensive goal-orientated curriculum within 90 days; achieve certification within two years from hire date

Continuing Educ. / Training

Maintains Certificates and/or Licenses as required and/or needed

Clearances

Criminal Background Clearance

WA State Sexual Misconduct Disclosure Release

FLSA Status

Non Exempt

Job Type: Full-time

Pay: $31.87 - $38.73 per hour

Benefits:

• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• In-person
• Office

Ability to Relocate:

• Tumwater, WA 98512: Relocate before starting work (Required)

Work Location: In person