Workers' Compensation Representative

City of Mesa•Mesa, AZ

2d•Onsite

About The Position

A Workers’ Compensation Representative is responsible for all aspects of claims management required by state statutes and the City of Mesa’s self-insured, self-administrative programs. The position's functions include: adjudicating workers’ compensation claims including, but not limited to determining compensability; authorizing or denying medical treatment; handling litigation; establishing Loss of Earning Capacity (LEC); assigning rehabilitation nurses and utilizing private investigators and vocational specialists; and filing notices with the Industrial Commission of Arizona (ICA). This position is responsible for calculating workers’ compensation indemnity such as Temporary Total Disability (TTD) or Temporary Partial Disability (TPD), and permanent awards such as Permanent Total Disability (PTD) or Permanent Partial Disability (PPD); approving medical bills for payment; and reporting expenditures through reports to administration and excess workers’ compensation carriers. This class assists injured workers, physicians, and other interested parties; explains workers’ compensation regulations and related City of Mesa policies and procedures; and resolves a variety of problems. This class works independently in the management and direction of simple to the most complex workers’ compensation claims and makes difficult decisions concerning medical and workers’ compensation benefits.

Requirements

Graduation from an accredited college or university with an Associate’s degree
Considerable (3 - 5 years) experience in workers’ compensation claims processing/adjudication as a workers’ compensation representative/adjuster
Good (1 - 3 years) experience working with Arizona Workers’ Compensation statutes, and state and federal regulations pertaining to workers’ compensation claims handling
Must possess an Arizona Adjuster Authorization Certification from the Industrial Commission of Arizona (ICA) by hire or promotion date

Responsibilities

Adjudicating workers’ compensation claims including, but not limited to determining compensability
Authorizing or denying medical treatment
Handling litigation
Establishing Loss of Earning Capacity (LEC)
Assigning rehabilitation nurses and utilizing private investigators and vocational specialists
Filing notices with the Industrial Commission of Arizona (ICA)
Calculating workers’ compensation indemnity such as Temporary Total Disability (TTD) or Temporary Partial Disability (TPD), and permanent awards such as Permanent Total Disability (PTD) or Permanent Partial Disability (PPD)
Approving medical bills for payment
Reporting expenditures through reports to administration and excess workers’ compensation carriers
Assisting injured workers, physicians, and other interested parties
Explaining workers’ compensation regulations and related City of Mesa policies and procedures
Resolving a variety of problems
Managing and directing simple to the most complex workers’ compensation claims
Making difficult decisions concerning medical and workers’ compensation benefits