W​/C Insurance Claims Specialist

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? Apply with us! 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 - $17.60
Grade: 17
Closing Date:
Open Until Filled

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.

• 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 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.

Claims adjusting license, certification (WCCA, WCCP,…