Workers Compensation Claims Adjuster 2

Arizona Department of Administration • Phoenix, AZ

8d • $65,000 - $70,000 • Hybrid

About The Position

This role combines high-level claims investigation and statutory oversight, focusing on complex determinations and the regulatory enforcement of bad faith and unfair claims processing pursuant to ARS 23-930. AAC R20-5-163. The W/C Claims Adjuster 2 investigates, evaluates, and analyzes complex Workers’ Compensation situations. This position serves as the primary lead for the Claims Division Bad Faith/Unfair Claims Processing Program, managing internal and externally filed complaints and handling the escalated process to completion. Responsibilities include issuing good faith and unfair claims processing practices awards, conducting complex audits and oversight and contributing to the divisional training programs. The role requires deep knowledge of the Arizona Workers’ Compensation Act and modern claims handling best practices to ensure industry compliance and provide technical guidance. 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

• Comprehensive knowledge of Title 23, Chapter 6 of the ARS (Arizona Workers Compensation Act).
• The Industrial Commission of Arizona Claims Division Operations.
• Claims adjusting practices.
• Excellent Knowledge of Microsoft Office, required.
• Basic business english and mathematics.
• Knowledge of using Internet based searching to conduct research.
• Strong writing skills.
• Effectively able to communicate verbally and in writing.
• Strong reasoning and analytical skills.
• Strong critical thinking and analysis.
• Data interpretation.
• Time Management.
• Initiative and attention to detail.
• Strong organization and planning skills
• Strong customer service skills
• Responsible for high-quality, nearly error-free output.
• Understand and learn computer systems and applications.
• Must demonstrate the ability to be use technology to problem solve, be a self learner in technology and continually enhance their skills in these areas to support our ongoing modernization momentum.
• Ability to write technical instructions.
• Interpret standard / simple claim files.
• Conduct research and reach a logical conclusion based on results.
• Manage heavy workload with high level of accuracy and production.
• Work well within a diverse and inclusive office environment.
• Timely process documents within established productivity standard and 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 judgement.
• Works well under pressure.
• Ability to perform job responsibilities incorporating lean management and principles of the Arizona Management System.
• Able to read and comprehend complex insurance, medical, and legal documents.

Nice To Haves

• Google Suite and Salesforce, a plus.

Responsibilities

• Identify, review, and process all requests for 1061M, internal and external complaints regarding bad faith or unfair claims practices.
• Manage the escalated dispute process to completion, conduct audits, analyze trends, and compile data into formal reports for leadership.
• Track payer claim status using Salesforce and other reporting software, make lifetime award determinations, and calculate average monthly wages or loss of earning awards.
• Enforce compliance efforts.
• Conduct Audits and complex research to proactively identify compliance issues.
• Make recommendations based on that research and develop internal and external programs to increase quality and compliance with existing Arizona WC laws, rules and statutes.
• Provide training to internal & external customers, technical advice, guidance, and troubleshooting support to peers and internal teams regarding complex claim issues.
• Support Annual Claims Seminar including updating the Claims Manual, creating and presenting dynamic presentation to community members.
• Provide back-up assistance to awards, compliance, customer service, wage, data entry, no match or insurance, as requested.

Benefits

• Sick leave
• Vacation with 10 paid holidays per year
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• 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

What This Job Offers

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