W/C CLAIMS ADJUSTER 1

State of Arizona; United States; Remote; USD 28,000 - 40,000; Full time

Benefits offered by this job

Sick leave

Vacation with 10 paid holidays per yr

Health and dental insurance

Retirement plan

Life insurance and long-term-disdi?b?l

Optional benefits include short-term/2

Job summary

The Industrial Commission of Arizona seeks a W/C Claims Adjuster 1 to handle complex workers’ compensation claims in the Special Fund Division. You will process time loss, permanent impairment, and vocational rehab claims while maintaining high levels of accuracy and customer service.

Strong knowledge of Arizona statutes, rules, and case decisions is essential, as is proficiency with Microsoft Office and the ability to collaborate with claimants, employers, attorneys, and providers.

Qualifications

• Knowledge of Arizona workers’ compensation statutes, rules and decisions.
• Experience with workers’ compensation claims processing procedures.
• Familiarity with vocational rehabilitation laws.
• Medical terminology and treatment protocols.
• Insurance and legal terminology.
• Proficiency in Microsoft Office and basic computer skills.

Responsibilities

• Process workers' compensation claims for time loss, permanent impairment, and Vocational Rehabilitation.
• Provide high-quality customer service to internal and external customers.
• Review, analyze and apply laws and procedures to determine claim eligibility.
• Conduct investigations and assign cases for further review.
• Evaluate claim value, reserves, and negotiate simple to complex settlements.
• Coordinate with claimants, employers, attorneys and medical providers.

Skills

Verbal & written communication

Dispute resolution

Complex document analysis

Laws, rules & court decisions

Critical thinking

Computer usage

Time management

Attention to detail

Customer service

Organization & planning

Tools

Microsoft Office

Microsoft Word

Excel

Google Suite

Job description

INDUSTRIAL COMMISSION

Are you ready to work for an exceptional state agency that works to protect the life, health, safety, and welfare of the employees in the State of Arizona? The Industrial Commission of Arizona (ICA) is committed to the highest standards of compliance, demonstrating leadership in all areas, and teaching and working with employers and employees to make them successful. A thriving workforce in Arizona is what we strive for and work towards each day.

W/C CLAIMS ADJUSTER 1

Job Location:

Special Fund Division

Address: 800 W Washington St., Phoenix AZ 85007

Posting Details:

Salary: $25.00

Grade: 19

Closing Date: November 13, 2026

Job Summary

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.

Job Duties

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.

Knowledge, Skills & Abilities (KSAs)

Knowledge of:

• 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

Skill in:

• 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

Ability to:

• 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.

Selective Preference(s)

Ideal candidate will possess 3 years of direct work related experience as a Claims Adjuster (Medical OnlyTime Loss). Arizona Workers Compensation Claims Administration (WCCA); Arizona Workers Compensation Claims Professional (WCCP), Chartered Property Casualty Underwriter (CPCU) and Arizona Adjuster Licenses are encouraged, but not required.

Pre-Employment Requirements

AZ Driver’s License Required: Must possess valid Arizona Driver's License. Required In-state and out-of-state travel is required. Requires possession of and ability to retain a current, valid state-issued driver's license appropriate to the assignment. Employees who drive on state business are subject to driver's license record checks, must complete any required driver training (See Arizona Administrative Code R2-10-207 (12). Employees may be required to use their own transportation, as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

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

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

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.

Contact Us

If you have any questions, please feel free to call 602-542-5559 or email [e-mail] for assistance.