W/C INSURANCE CLAIMS SPECIALIST 2

Job Summary:

This position is responsible to audit incoming claims documents for compliance with applicable workers compensation claims management laws, statutes, and case laws.

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.

Job Duties:

Essential Duties and Responsibilities include but are not limited to:
● This position will 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.
● Reviews all notices, attached medical and/or documentation to verify it supports current change of status and/or calculation of wage and awards. After analysis, specialist will issue correct corresponding award, notification, or document.
● Answer incoming phone calls from injured workers, attorneys, interested parties, claim adjusters, medical providers, and the general public.
● Matches documents lacking information to existing Commission claims files by researching information in Claims database and for creating a new claim file for documents received when there is no existing claim file.
● Provides backup assistance to data entry, error resolution, insurance or combine/delete, as requested and
● Participates in Arizona Management System (AMS) and daily Huddle board.
● Attends staff meetings, seminars, conferences, training classes.

Knowledge, Skills & Abilities (KSAs):

Knowledge in
● Basic knowledge or ability to learn of applicable workers compensation claims management laws, statutes, and case laws.
● Basic Medical terminology.
● Microsoft Office Suite; Outlook, Word, Excel, Google Office Suite, Gmail, Sheets and Docs
● Basic English
● Basic Mathematics
● The insurance industry claims adjusting standards and practices.

● Skill in:
● Communicating verbally and in writing to resolve disputes with interested parties.
● Basic analysis of insurance, medical and legal documents.
● Reviewing and interpreting Arizona Workers' Compensation laws, rules, procedures, and court decisions
● Critical thinking
● Time Management
● Initiative and attention to detail
● Customer service
● Organizing and planning
● Basic Business process acumen, management skills including workflows and information management.

● Ability to:
● 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.
● Process documents in a timely manner and within established productivity standard.
● 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.
● Perform job responsibilities incorporating lean management and principles of the Arizona Management System.
● Produce high quality, nearly error-free output.

Selective Preference(s):

The ideal candidate for this position will have:
Claims adjusting license, certification (WCCA, WCCP, CPCU) or designation relating to workers' compensation.

Pre-Employment Requirements:

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Benefits:

The Arizona Department of Administration offers a comprehensive benefits package to include:
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

By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

For a complete list of benefits provided by The State of Arizona, please visit our

Retirement:

You will be eligible to participate in the state employee health/disability insurance plan, and you are required to participate in the Arizona State Retirement System (ASRS). ASRS participation may begin immediately or upon your 27th week of employment. Contributions are matched by the employer.