W/C Claims Adjuster 1

Arizona Department of Administration•Phoenix, WA

10d•Onsite

About The Position

The Industrial Commission of Arizona (ICA) is hiring a W/C Claims Adjuster 1 for its Special Fund Division. The position processes workers’ compensation benefits for No Insurance, Bankrupt Self-Insured, Pre-1973 Supportive Care, and Vocational Rehabilitation claims. The adjuster handles journey-level professional claims involving time loss, permanent impairment, permanently awarded benefits, and vocational rehabilitation. The employee works under supervision while exercising independent judgment within established guidelines and procedures. The role includes reviewing and managing claims, making compensability decisions, authorizing benefits, analyzing medical and legal information, conducting investigations, managing reserves, and negotiating settlements. The adjuster provides timely customer service to internal and external customers and prioritizes work to meet established deadlines. The position requires a valid Arizona driver’s license and in-state and out-of-state travel. Employees driving on state business may need to use personal transportation, maintain valid vehicle insurance and Arizona registration, and complete required driver training; mileage is reimbursed.

Requirements

Must possess a valid Arizona driver’s license appropriate to the assignment and be able to retain it.
Required in-state and out-of-state travel.
Knowledge of Arizona workers’ compensation statutes, rules of procedure, regulations, and relevant Court of Appeals and Supreme Court decisions.
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 skills.
Strong verbal and written communication skills.
Skill in dispute resolution.
Ability to analyze insurance, medical, and legal documents of moderate to high complexity and reach logical claims determinations.
Ability to review, interpret, and apply laws, rules, procedures, and court decisions.
Strong critical-thinking skills.
Computer skills, time-management ability, initiative, and attention to detail.
Strong customer-service focus and organizational and planning skills.
Ability to interpret large and complex claim files.
Ability to manage a heavy workload with a high level of accuracy and production.
Ability to learn computer systems and applications.
Ability to work well in a diverse and inclusive office environment, manage time effectively, and meet deadlines.
Ability to adapt to changing circumstances, exercise discretion and judgment, and work well under pressure.

Nice To Haves

Three years of direct, related experience as a Claims Adjuster (Medical Only/Time Loss) is preferred.
Arizona Workers Compensation Claims Administration (WCCA) certification is encouraged but not required.
Arizona Workers Compensation Claims Professional (WCCP) certification is encouraged but not required.
Chartered Property Casualty Underwriter (CPCU) designation is encouraged but not required.
Arizona Adjuster License is encouraged but not required.

Responsibilities

Manage claims involving time loss, permanent impairment, permanently awarded benefits, and vocational rehabilitation.
Provide high-quality, timely customer service to internal and external customers by building professional relationships.
Process workers’ compensation claims and benefits accurately and within established time frames.
Review, analyze, and proactively manage claims to ensure legal and timely benefits.
Apply internal Best Practices standards, Occupational Disability Guidelines, Arizona workers’ compensation laws, rules and case law, and the Arizona Fee Schedule.
Conduct claims investigations and assign cases for additional investigation when needed.
Analyze and investigate time-loss claims and complete compensability decisions.
Identify claims with subrogation potential.
Review medical reports to determine changes in claim status and identify opportunities for claim-management interventions.
Review and authorize medical bills.
Arrange independent medical examinations when indicated.
Evaluate claim value and negotiate simple to complex settlements.
Develop and maintain reserves and plans of action to manage claims to 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 claims work within established time frames.
Maintain timely claims processing.
Travel in and out of state as required.
Complete required driver training if applicable when driving on state business.

Benefits

Sick leave.
Vacation leave.
10 paid holidays per year.
Health insurance.
Dental insurance.
Retirement plan through the Arizona State Retirement System (ASRS), with employer-matched contributions.
Life insurance.
Long-term disability insurance.
Optional short-term disability insurance.
Optional deferred compensation plans.
Optional supplemental life insurance.
Mileage reimbursement for required use of personal transportation on state business.