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State of Washington Classified Job Specification

WORKERS' COMPENSATION ADJUDICATOR 6

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WORKERS' COMPENSATION ADJUDICATOR 6
Class Code: 168E
Category: Financial Services


Class Series Concept

See Worker’s Compensation Adjudicator 1.

Definition

In the Department of Labor and Industries, this is the supervisory level of the series. Positions at this level operate as the expert in their field and serve as a resource by providing guidance on specialized, technical issues to all levels of staff including management and external stakeholders.

Distinguishing Characteristics

Under administrative direction, supervises a unit of workers’ compensation adjudicators and work on the most complex, challenging, and critical issues facing their respective programs.

Typical Work

Coordinates, supervises and directs workers' compensation adjudicators and clerical staff assigned to a unit; Hires, conducts employee performance reviews; provides training and guidance to staff; takes corrective action where indicated;

Plans, prioritizes, assigns and evaluates the work of staff to ensure that determinations for benefits, medical and vocational rehabilitation management are consistent with current Revised Codes of Washington, Washington Administrative Codes and Department policy and procedures;

Acts as technical and professional resource to assigned staff, managers and elected officials in resolution of complex or sensitive cases involving coordination of legal, medical, and vocational rehabilitation aspects of workers' compensation claims or crime victims’ compensation claims;

Reviews and takes action on Board Industrial Insurance Appeals decisions and judgements from Superior Court, Court of Appeals and the Washington State Supreme Court.

Participates in the development of WACs, departmental policies, procedures and performance standards required for the implementation of the program;

Ensures payments are appropriate and recipients are not on the specially designated nationals and blocked list to comply with the Office of Foreign Assets Control;

Interacts with elected officials, physicians, and other medical and vocational rehabilitation providers, attorneys, employers, and injured workers, crime victims, victim advocates and others involved in the Industrial Insurance process;

Conducts and participates in interdisciplinary case conferences;

Analyzes legislation affecting workers’ compensation program; determines fiscal impacts; collaboratively develops and implements strategies to meet business and training needs due to new legislation;

Participates in the administration of the Workers’ Compensation Adjudicator 2 – Apprenticeship Program; Identifies performance deficiencies and recommends performance improvement plans to ensure compliance with the Standards of Apprenticeship approved through the Joint Apprenticeship Training Council;

Supervises the performance of workers’ compensation overall system quality reviews and the internal financial examinations of benefit payments;

Oversee day to day operations to ensure accuracy and compliance with governing laws, rules, policy and established work standards and process;

Perform the duties of the lower level in the series;

Performs other work as required.

Knowledge and Abilities

Knowledge of: Workers' Compensation and Medical Aid Acts and other statutes, court decisions, Attorney General Opinions, Board of Industrial Appeals rulings, and departmental regulations applying to industrial accidents and occupational diseases, past and present, or disability insurance provisions of the Old Age and Survivors Insurance Act; medical terminology, human anatomy and physiology, psychiatric terms, drugs, prosthetic devices and their indications; tort law pertaining to third party actions.

Ability to: exercise mature judgment in adjudicating disability claims and counterclaims from disabled workers, physicians, employers, third parties and other persons; personally make lawful and equitable determinations regarding eligibility for benefits under the law; write clear, concise, accurate and informative correspondence and reports; establish and maintain effective customer relations and working relationships with workers, physician, employers, legal representatives, co-workers and the general public; compare past records, past and present law, rulings of the Board of Industrial Insurance Appeals and higher courts, and other information to arrive at lawful and equitable decisions regarding benefit entitlements.

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Persons legally authorized to work in the U.S. under federal law, including Deferred Action for Childhood Arrivals recipients, are eligible for employment unless prohibited by other state or federal law.

Desirable Qualifications

Successful completion of the Department of Labor and Industries Workers’ Compensation Adjudicator 2 Apprenticeship program

AND

One year of experience as a Workers’ Compensation Adjudicator 5.

OR

Two years of experience as a Workers’ Compensation Adjudicator 4.

OR

Bachelor’s degree in business administration, public administration or closely allied field;


AND

Five years of experience in adjudicating workers' or crime victims' compensation insurance claims, or adjudication of time loss payments. Experience must include one year of management, leading teams or supervising.

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.

Equivalent education/experience.

Class Specification History

New class: December 15, 1972.
General revision and title change (formerly Workmen's Compensation Unit Supervisor): September 7, 1973.
Revised definition: April 12, 1985.
Revised minimum qualifications: December 13, 1985.
Revised definition, distinguishing characteristics and minimum qualifications: September 11, 1987.
Revised definition and minimum qualifications, deletes distinguishing characteristics: May 1, 1990.
Revised definition and minimum qualifications: September 10, 1999.
Revised new class code: (formerly 46860) effective July 1, 2007.
Revised definition, typical work, knowledge and abilities, desirable qualifications, and new class title (formerly Industrial Insurance Compensation Unit Supervisor), class series concept, distinguishing characteristics, adopted June 22, 2023, effective July 01, 2023.
Revised legal requirements; effective June 6, 2024, due to adopted legislative action.
Revised definition, distinguishing characteristics, typical work, desired qualifications; base range increase from 61 to 62; adopted June 23, 2025, effective July 1, 2025.