Claims Specialist Jobs

About The Position

Requirements

• Basic knowledge of applicable workers compensation claims management laws, statutes, and case laws.
• Basic Medical terminology.
• Microsoft Office Suite; Outlook, Word, Excel.
• Basic English
• Basic Mathematics
• The insurance industry claims adjusting standards and practices.
• Effectively able to communicate verbally and in writing to resolve disputes with interested parties.
• Basic analysis of insurance, medical and legal documents.
• Review and interpret Arizona Workers' Compensation laws, rules, procedures and court decisions
• Strong critical thinking skills
• Time Management
• Initiative and attention to detail
• Strong focus on customer service
• Strong organizational and planning skills
• Responsible for high quality, nearly error-free output
• Basic organizational, analytical, managerial and supervisory skills.
• Basic Business process acumen, management skills including work flows and information management.
• Strong leadership, time management, and organizational skills.
• 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.
• Timely process documents within established productivity standard and prioritizes 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.
• Ability to perform job responsibilities incorporating lean management and principles of the Arizona Management System.
• Effectively train internal and external customers in small and large group settings.
• High School Diploma or equivalent

Nice To Haves

• Equivalent experience in Arizona Workers Compensation claims management may be substituted for basic knowledge.

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.
• Issue correct corresponding award, notification, or document after analysis.
• Answer incoming phone calls from injured workers, attorneys, interested parties, claim adjusters, medical providers and general public.
• Match documents lacking information to existing Commission claims files by researching information in Claims database.
• Create 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; as indicated.
• Demonstrate all skills required for Workers Compensation Specialist I in addition to basic knowledge, research and analytical skills required to independently complete all compliance section processes.

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
• Paid Parental Leave program