This position may offer the ability to work a hybrid remote work schedule (1 or more days per week), based upon the department's business needs and continual meeting of expected performance measures.
This position of the Workers Compensation is responsible for auditing claims documents for compliance with applicable workers compensation claims management laws, statutes, and case laws.
This position will 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 Average Monthly Wage. This job involves moderate amount of customer contact and repetitive review of recommended average monthly wage forms, performing review of calculations using internal software and tools to assist and approving/denying the request. After analysis, the Specialist will issue correct corresponding award, notification, or document; answer incoming phone calls from injured workers, attorneys, interested parties, claim adjusters, medical providers, and public. Additionally, this position will be responsible for matching 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; provide backup assistance to compliance, data entry, error resolution, no match or combine/delete as requested; participates in Arizona Management System (AMS) and daily Huddle board; attend staff meetings, seminars, conferences, training classes as required.
This position demonstrates 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. This knowledge may be substituted with the equivalent experience in Arizona Workers Compensation claims management.
• Basic knowledge or ability to learn applicable workers compensation claims management laws, statutes, case laws.
• Basic Medical terminology.
• Microsoft Office Suite; Outlook, Word, Excel.
• Basic English
• Basic Mathematics
• 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 skills.
• 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, 5+ years of customer service experience and/or workers compensation insurance.
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.