W/C Insurance Claims Specialist 2

Arizona Department of Administration • Phoenix, WA

2d • Hybrid

About The Position

The Industrial Commission of Arizona’s Claims Division/Compliance Section is hiring a W/C Insurance Claims Specialist 2. The position audits incoming workers’ compensation claims documents for compliance with applicable claims-management laws, statutes, and case law. It may offer remote work within Arizona, 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.

The specialist analyzes submitted forms, verifies supporting medical and other documentation, and issues appropriate awards, notifications, or documents. The role also audits insurance carriers, self-insured employers, and third-party administrators handling workers’ compensation claims; responds to inquiries from injured workers, attorneys, claim adjusters, medical providers, interested parties, and the public; and researches the Claims database to match incomplete documents to existing files or create new claim files. The specialist provides backup support for data entry and related processes and participates in Arizona Management System activities and daily Huddles. The position requires the knowledge, research, and analytical skills to independently complete 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. Salary is $17.05–$17.60, Grade 17. The posting is open until filled.

Requirements

• 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 knowledge.
• 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 skills, time management, initiative, and attention to detail.
• Strong customer-service focus and organizational and planning skills.
• Ability to produce high-quality, nearly error-free work.
• Basic organizational, analytical, managerial, and supervisory skills.
• Basic business-process acumen and management skills, 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.
• Ability to learn computer systems and applications.
• Ability to work in a diverse and inclusive office environment.
• Ability to process documents promptly within productivity standards and prioritize work within established time frames.
• Ability to meet deadlines, adapt to changing circumstances, exercise discretion and judgment, and work under pressure.
• Ability to incorporate lean management principles and the Arizona Management System into job responsibilities.
• Ability to train internal and external customers in small and large group settings.
• High school diploma or equivalent (selective preference).
• New hires must successfully complete E-Verify.
• If driving or use of a vehicle is required as an essential job function, the stated Driver’s License Requirements apply.

Responsibilities

• 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 notices and supporting medical or other documentation to verify changes in status and wage or award calculations.
• Issue the corresponding award, notification, or document after analysis.
• Answer incoming calls from injured workers, attorneys, interested parties, claim 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 Arizona Management System activities and daily Huddles.
• Attend staff meetings, seminars, conferences, and training classes as indicated.
• Independently complete Compliance Section processes using research and analytical skills.

Benefits

• Sick leave.
• Vacation and 10 paid holidays per year.
• Health and dental insurance.
• Retirement plan through the Arizona State Retirement System; employer contributions are matched.
• Life insurance and long-term disability insurance.
• Optional short-term disability insurance, deferred compensation plans, and supplemental life insurance.
• Paid parental leave program.
• Remote-work option may support improved work/life balance, subject to management discretion.

What This Job Offers

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