This position is responsible for performing work associated with processing workers' compensation benefits for the following Special Fund programs: No Insurance, Bankrupt Self-Insured, Pre-1973 Supportive Care, and Vocational Rehabilitation claims.
File handling of journey level professional claims management of the following status’: time loss, permanent impairment, permanently awarded (as defined by a Loss of Earning Capacity award and/or Supportive Care), and Vocational Rehabilitation. Employee works under supervision and exercises independent judgment within established guidelines and procedures.
Other duties include but are not limited to: providing high quality and timely customer service to internal and external customers by building a professional relationship; performing work of moderate complexity associated with workers' compensation claims processing inclusive of timely processing of claims; reviewing, analyzing and proactively managing workers compensation claims to ensure legal and timely benefits; analyzing and applying advanced concepts of the following; internal Best Practices standards, Occupational Disability Guidelines, Arizona Workers' Compensation laws, rules and case law decisions, Arizona Fee Schedule; conducting claims investigations, assigns cases for additional investigation; analyzing, investigating, and completing compensability decisions on time loss (indemnity) claims; identifying claims with subrogation potential; critically reviewing medical reports to determine change in claim status and maximizes opportunities for claim management interventions; reviewing and authorizing medical bills;
completing independent medical examinations as indicated; evaluating claim value for settlement and negotiates simple to complex settlements; developing and maintaining reserves and plan of action to manage the claim to resolution; exercising independent judgment within established authority levels; initiating contact with claimants, employers, attorneys, or medical providers; establishing Average Monthly Wage; authorizing compensation and medical benefits; including Loss of Earning Capacity and Fatalities; and responsible for timely processing of claims and prioritizing work within established time frames.
• Arizona workers’ compensation statutes, rules of procedure, regulations, Court of Appeals
and Supreme Court decisions regarding workers’ compensation law.
• Workers' compensation claims processing procedures and best practices.
• Federal and State vocational rehabilitation laws.
• Medical terminology and treatment protocols, and Occupational Disability Guidelines.
• Insurance and legal terminology
• Microsoft Office; Word, Excel, Google Suite.
• Basic English
• Basic Mathematics
• Strong verbal and written communication skills.
• Dispute resolution.
• Analyzing insurance, medical and legal documents of moderate to high complexity to
reach logical claims determinations.
• Reviewing, interpreting and applying laws, rules, procedures and court decisions.
• Strong critical thinking skills.
• Computer usage.
• Time Management.
• Initiative and attention to detail.
• Strong focus on customer service
• Strong organizational and planning skills
• Interpret large & complex claim files.
• Manage heavy workload with high level of accuracy and production.
• Learn computer systems and applications.
• Work well within a diverse and inclusive office environment.
• Manage time effectively and meet deadlines.
• Adapt to changing circumstances.
• Demonstrate initiative and attention to detail.
• Exercise discretion and judgment.
• Works well under pressure.
• An Arizona Adjusters License and Industry Certification such as Workers Compensation of America (WCCA), Workers’ Compensation Claims Professional (WCCP) and Chartered Property Casualty Underwriter (CPCU).
The Arizona Department of Administration offers a comprehensive benefits package to include:
Vacation with 10 paid holidays per year
Health and dental insurance
Life insurance and long-term disability insurance
Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
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.
If you have any questions, please feel free to call 602-542-5559 or email HR@azica.gov for assistance.
ARIZONA MANAGEMENT SYSTEM (AMS)
All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results.
State employees are highly engaged, collaborative and embrace a culture of public service.
The State of Arizona is an Equal Employment Opportunity Employer.