W/C CLAIMS ADJUSTER 1

Arizona Department of Administration • Phoenix, AZ

11d • Onsite

About The Position

This position processes workers' compensation benefits for the Special Fund Division's No Insurance, Bankrupt Self-Insured, Pre-1973 Supportive Care, and Vocational Rehabilitation programs. The role handles journey-level claims management for time-loss, permanent-impairment, permanently awarded, and vocational rehabilitation claims. The employee works under supervision while exercising independent judgment within established guidelines and procedures.

The position provides timely customer service and processes, reviews, investigates, and manages claims in accordance with applicable laws, regulations, case decisions, guidelines, and internal best practices. Duties include making compensability decisions, reviewing medical reports and bills, authorizing benefits, managing reserves and claim action plans, evaluating claims and negotiating settlements, identifying subrogation potential, establishing average monthly wages, and prioritizing work to meet required timelines.

Requirements

• Possess a valid Arizona driver's license and retain a current, valid state-issued driver's license appropriate to the assignment.
• Be able to travel in-state and out-of-state.
• Be able to use personal transportation for state business when required, maintain valid motor vehicle insurance and current Arizona vehicle registration, and complete required driver training and record checks.
• Knowledge of Arizona workers' compensation statutes, rules of procedure, regulations, and Court of Appeals and Supreme Court decisions regarding workers' compensation law.
• Knowledge of workers' compensation claims processing procedures and best practices.
• Knowledge of federal and state vocational rehabilitation laws.
• Knowledge of medical terminology, treatment protocols, and Occupational Disability Guidelines.
• Knowledge of insurance and legal terminology.
• Knowledge of Microsoft Office (Word and Excel) and Google Suite.
• Basic English and mathematics knowledge.
• Strong verbal and written communication skills.
• Skill in dispute resolution and in analyzing insurance, medical, and legal documents of moderate to high complexity to reach logical claims determinations.
• Skill in reviewing, interpreting, and applying laws, rules, procedures, and court decisions.
• Strong critical thinking, computer usage, time management, initiative, attention to detail, customer service, organization, and planning skills.
• Ability to interpret large and complex claim files and manage a heavy workload with a high level of accuracy and production.
• Ability to learn computer systems and applications, work well in a diverse and inclusive office, manage time and meet deadlines, adapt to changing circumstances, demonstrate initiative and attention to detail, exercise discretion and judgment, and work well under pressure.

Nice To Haves

• Three years of direct work-related experience as a Claims Adjuster (Medical Only/Time Loss).
• Arizona Workers Compensation Claims Administration (WCCA) credential.
• Arizona Workers Compensation Claims Professional (WCCP) credential.
• Chartered Property Casualty Underwriter (CPCU) credential.
• Arizona Adjuster License.

Responsibilities

• Manage time-loss, permanent-impairment, permanently awarded, and vocational rehabilitation claims.
• Provide high-quality, timely customer service to internal and external customers and build professional relationships.
• Process workers' compensation claims in a timely manner.
• Review, analyze, and proactively manage claims to ensure legal and timely benefits.
• Apply internal best-practice standards, Occupational Disability Guidelines, Arizona workers' compensation laws and rules, case law decisions, and the Arizona Fee Schedule.
• Conduct claims investigations and assign cases for additional investigation.
• Analyze and complete compensability decisions on time-loss (indemnity) claims.
• Identify claims with subrogation potential.
• Review medical reports to determine claim-status changes and identify claim-management interventions.
• Review and authorize medical bills.
• Complete independent medical examinations as indicated.
• Evaluate claim value and negotiate settlements ranging from simple to complex.
• Develop and maintain reserves and plans of action to manage claims through resolution.
• Exercise independent judgment within established authority levels.
• Initiate contact with claimants, employers, attorneys, and medical providers.
• Establish Average Monthly Wage.
• Authorize compensation and medical benefits, including Loss of Earning Capacity and fatality benefits.
• Prioritize work within established time frames.

Benefits

• Sick leave.
• Vacation and 10 paid holidays per year.
• Health and dental insurance.
• Retirement plan with employer-matched contributions.
• Life insurance and long-term disability insurance.
• Optional short-term disability insurance, deferred compensation plans, and supplemental life insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed