W/C INSURANCE CLAIMS SPECIALIST 2

Arizona Department of Administration • Phoenix, AZ

3d • $17 - $18

About The Position

The W/C Insurance Claims Specialist 2 works in the Industrial Commission of Arizona’s Claims Division/Compliance Section. The position audits incoming workers’ compensation claims documents for compliance with applicable claims management laws, statutes, and case law. It critically analyzes submitted forms, verifies that notices and supporting medical or other documentation substantiate changes in status and wage or benefit calculations, and issues the appropriate awards, notifications, or documents. The specialist also audits insurance carriers, self-insured employers, and third-party administrators that adjust workers’ compensation claims.

The role matches incomplete documents to existing Commission claims files through research in the Claims database and creates new claim files when necessary. It answers inquiries from injured workers, attorneys, interested parties, claims adjusters, medical providers, and the public, and may provide backup support for data entry, error resolution, insurance, or combine/delete processes. The position participates in the Arizona Management System and daily Huddle board, and attends meetings, seminars, conferences, and training as needed. It requires the skills of a Workers Compensation Specialist I, along with the knowledge, research, and analytical skills to independently perform Compliance Section processes. Equivalent experience in Arizona workers’ compensation claims management may substitute for this knowledge.

The position is based at 800 W. Washington Street, Phoenix, Arizona. Remote work within Arizona may be available depending on business needs and continued achievement of performance measures; remote work is a management option and may be discontinued at the agency’s discretion.

Requirements

• High school diploma or equivalent is listed as a selective preference.
• Basic knowledge of applicable workers’ compensation claims management laws, statutes, and case law.
• Basic medical terminology.
• Knowledge of Microsoft Office Suite, including Outlook, Word, and Excel.
• Basic English and mathematics skills.
• Knowledge of insurance industry claims-adjusting standards and practices.
• Ability to communicate verbally and in writing to resolve disputes with interested parties.
• Ability to analyze insurance, medical, and legal documents.
• Ability to review and interpret Arizona workers’ compensation laws, rules, procedures, and court decisions.
• Strong critical-thinking, time-management, organizational, planning, leadership, and attention-to-detail skills.
• Strong customer-service focus and ability to produce high-quality, nearly error-free work.
• Basic organizational, analytical, managerial, and supervisory skills, and basic business-process acumen, including workflows and information management.
• Ability to interpret medical records to determine injured workers’ physical limitations.
• Ability to manage a heavy workload with accuracy and productivity, learn computer systems and applications, and work effectively in a diverse and inclusive office environment.
• Ability to adapt to changing circumstances, exercise discretion and judgment, and work well under pressure.
• Ability to perform job responsibilities using lean management principles and the Arizona Management System.
• Ability to independently complete Compliance Section processes using the required knowledge, research, and analytical skills; equivalent Arizona workers’ compensation claims management experience may substitute for this knowledge.
• New State employees must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
• If driving or use of a vehicle is an essential job function for State business, the stated driver’s license requirements apply.

Responsibilities

• Audit incoming claims documents for compliance with applicable workers’ compensation claims management laws, statutes, and case law.
• Analyze submitted forms and issue appropriate awards when indicated.
• Audit insurance carriers, self-insured employers, and third-party administrators that adjust workers’ compensation claims.
• Review notices and supporting medical or other documentation to verify changes in status and calculations of wages and awards.
• Issue the correct corresponding award, notification, or document after analysis.
• Answer incoming calls from injured workers, attorneys, interested parties, claims adjusters, medical providers, and the general public.
• Research the Claims database to match documents lacking information to existing Commission claims files.
• Create a new claim file when received documents do not correspond to an existing file.
• Provide backup assistance for data entry, error resolution, insurance, or combine/delete processes as requested.
• Participate in the Arizona Management System and daily Huddle board.
• Attend staff meetings, seminars, conferences, and training classes as indicated.
• Process documents within established productivity standards, prioritize work, and meet deadlines.
• Train internal and external customers in small- and large-group settings.

Benefits

• Sick leave
• Vacation and 10 paid holidays per year
• Health and dental insurance
• Retirement plan, including required participation in the Arizona State Retirement System with employer-matched contributions
• Life insurance and long-term disability insurance
• Optional short-term disability insurance
• Optional deferred compensation plans
• Optional supplemental life insurance
• Paid parental leave program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED