W/C Insurance Specialist

Description

This position of the Workers Compensation is responsible forauditing claims documents for compliance with applicable workers compensationclaims management laws, statutes, and case laws.

This position will auditinsurance carriers, self-insured employers and third-party administratorsadjusting workers compensation claims;

reviews all notices, attached medicaland / or documentation to verify it supports current change of status and / orcalculation of Average Monthly Wage.

This job involves moderate amount ofcustomer contact and repetitive review of recommended average monthly wageforms, performing review of calculations using internal software and tools toassist and approving / denying the request.

After analysis, the Specialist willissue correct corresponding award, notification, or document; answer incomingphone calls from injured workers, attorneys, interested parties, claimadjusters, medical providers, and public.

• Additionally, this position will beresponsible for matching documents lacking information to existing Commissionclaims files by researching information in Claims database and for creating anew claim file for documents received when there is no existing claim file;
• provide backup assistance to compliance, data entry, error resolution, no matchor combine / delete as requested; participates in Arizona Management System (AMS)and daily Huddle board;

attend staff meetings, seminars, conferences, trainingclasses as required.

Skills Required

• Basic knowledge or ability to learnapplicable workers compensation claims management laws, statutes, case laws.
• Basic Medical terminology.
• Microsoft Office Suite; Outlook, Word, Excel.
• Basic English
• Basic Mathematics Skill in :
• Effectively able to communicate verbally andin writing to resolve disputes with interested parties.
• Basic analysis of insurance, medical andlegal documents.
• Review and interpret Arizona Workers'Compensation laws, rules, procedures, and court decisions
• Strong criticalthinking skills
• Time Management
• Initiative and attention to detail
• Strong focus on customer service
• Strong organizational and planning skills
• Responsible for high quality, nearlyerror-free output
• Basic organizational, analytical skills.Ability to :
• Manage heavy workload with high level ofaccuracy and production.
• Learn computer systems and applications.
• Work well within a diverse and inclusiveoffice environment.
• Timely process documents within establishedproductivity standard and prioritizes work within established time frames.
• Manage time effectively and meet deadlines.
• Adapt to changing circumstances.
• Demonstrate initiative and attention todetail.
• Exercise discretion and judgment.
• Works well under pressure.
• Ability to perform job responsibilitiesincorporating lean management and principles of the Arizona Management System.
• Effectively train internal and externalcustomers in small and large group settings.

Experience Required

5+ years of customer service experience and / orworkers compensation insurance

Education Required

High school diploma