W/C INSURANCE CLAIMS SPECIALIST 2

Arizona State Government; Phoenix (AZ); Hybrid; USD 23,000 - 29,000; 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 disabled

Job summary

Industrial Commission of Arizona is seeking a W/C Insurance Claims Specialist 2 to audit incoming claims for compliance with workers' compensation laws and to issue appropriate awards when indicated. Some remote work within Arizona may be available based on performance and business needs.

Responsibilities include reviewing notices, researching records in the Claims database, and assisting with file creation or updates. Strong attention to detail and customer service are essential in this role.

Qualifications

• Knowledge of workers' compensation claims management laws, statutes, and case laws.
• Basic medical terminology.
• Proficiency with Microsoft Office (Outlook, Word, Excel).
• Basic English communication skills.
• Basic mathematics.
• Familiarity with insurance claims adjusting standards and practices.

Responsibilities

• Audit incoming claims documents for compliance with workers' compensation laws and regulations.
• Review notices and attached medical/documents to verify support for status, wage, and awards; issue correct awards.
• Respond to calls from injured workers, attorneys, claim adjusters, medical providers and the public.
• Match documents to existing claims or create new claim files as needed; provide backup data-entry support.

Skills

Communication

Analytical thinking

Microsoft Office

Time management

Customer service

Attention to detail

Education

High school diploma or equivalent

Job description

INDUSTRIAL COMMISSION

Are you ready to work for an exceptional state agency that works to protect the life, health 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 INSURANCE CLAIMS SPECIALIST 2

Job Location:

Address: Claims Division/Compliance Section
800 W. Washington Street, Phoenix, AZ 85007

Salary: 17.05

Grade: 17

Closing Date: Open Until Filled

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 remote, 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 remote 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:

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 general 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 data entry, error resolution, insurance or combine/delete, as requested and participates in Arizona Management System (AMS) and daily Huddle board; attend staff meetings, seminars, conferences, training classes; as indicated.
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.

Knowledge, Skills & Abilities (KSAs)

Knowledge of:

• Basic knowledge of applicable workers compensation claims management laws, statutes, and case laws.
• Basic Medical terminology.
• Microsoft Office Suite; Outlook, Word, Excel.
• Basic English
• Basic Mathematics
• The insurance industry claims adjusting standards and practices.

Skill in:

• 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, managerial and supervisory skills.
• Basic Business process acumen, management skills including work flows and information management.
• Strong leadership, time management, and organizational skills.

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.
• 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.

Selective Preference(s):

High School Diploma or equivalent;

Pre-Employment Requirements:

If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License 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.

Learn more about the Paid Parental Leave program here. 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.