W/C INSURANCE CLAIMS SPECIALIST 2
About The Position
This position is responsible to audit incoming claims documents for compliance with applicable workers compensation claims management laws, statutes, and case laws. This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures. The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.
Requirements
- Basic knowledge or ability to learn of applicable workers compensation claims management laws, statutes, and case laws.
- Basic Medical terminology.
- Microsoft Office Suite; Outlook, Word, Excel, Google Office Suite, Gmail, Sheets and Docs
- Basic English
- Basic Mathematics
- The insurance industry claims adjusting standards and practices.
- Communicating verbally and in writing to resolve disputes with interested parties.
- Basic analysis of insurance, medical and legal documents.
- Reviewing and interpreting Arizona Workers' Compensation laws, rules, procedures, and court decisions
- Critical thinking
- Time Management
- Initiative and attention to detail
- Customer service
- Organizing and planning
- Basic Business process acumen, management skills including workflows and information management.
- Interpret medical records to determine physical limitations for injured workers.
- Manage heavy workload with high level of accuracy and production.
- Learn computer systems and applications.
- Work well within a diverse and inclusive office environment.
- Process documents in a timely manner and within established productivity standard.
- Prioritize work within established time frames.
- Manage time effectively and meet deadlines.
- Adapt to changing circumstances.
- Demonstrate initiative and attention to detail.
- Exercise discretion and judgment.
- Works well under pressure.
- Perform job responsibilities incorporating lean management and principles of the Arizona Management System.
- Produce high quality, nearly error-free output.
Nice To Haves
- Claims adjusting license, certification (WCCA, WCCP, CPCU) or designation relating to workers' compensation.
Responsibilities
- Critically analyze submitted forms for compliance and issue appropriate awards when indicated.
- Audit insurance carriers, self-insured employers and third-party administrators adjusting workers’ compensation claims.
- Review all notices, attached medical and/or documentation to verify it supports current change of status and/or calculation of wage and awards. After analysis, specialist will issue correct corresponding award, notification, or document.
- Answer incoming phone calls from injured workers, attorneys, interested parties, claim adjusters, medical providers, and the general public.
- Match documents lacking information to existing Commission claims files by researching information in Claims database and for creating a new claim file for documents received when there is no existing claim file.
- Provide backup assistance to data entry, error resolution, insurance or combine/delete, as requested.
- Participate in Arizona Management System (AMS) and daily Huddle board.
- Attend staff meetings, seminars, conferences, training classes.
Benefits
- Sick leave
- Vacation with 10 paid holidays per year
- Health and dental insurance
- Retirement plan
- Life insurance and long-term disability insurance
- Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance
- Improved work/life balance
- Higher job satisfaction
- More productive
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
