What are the responsibilities and job description for the W/C INSRNCE CLMS SPCT position at State of Arizona?
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. File handling of entry level claims management of the following status’: medical only, supportive care, facility, and Loss of Earning Capacity.
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; reviewing, analyzing and proactively managing workers compensation claims to ensure legal and timely benefits; analyzing and applies the following: internal best practices standards, Occupational Disability Guidelines, Arizona Workers’ Compensation laws, rules and case law decisions; analyze, investigate and complete compensability decisions on Medical Only claims; conducts claims investigations; identifies claims with subrogation potential; critically reviews medical reports to determine change in claim status and maximizes opportunities for claim management interventions; review and authorize medical bills, as indicated; requests independent medical examination; when indicated; sends and follows up on Annual Report of Income and Widow/Dependent status letters;
negotiates and settles claims; develop and maintain reserves and plan of action to manage the claim to resolution; exercises independent judgment within established authority levels; initiates contact with claimants, employers, attorneys, or medical providers; authorizes medical benefits; responsible for timely processing of claims scheduling and prioritizing work within established time frames; participates in Arizona Management System (AMS) and daily huddle boards; attend staff meetings, seminars, conferences, training classes as indicated.
Knowledge of:
- Policies and procedures pertaining to Arizona workers' compensation claims adjusting.
- Verbal and written communication skills.
- Insurance, legal and medical terminology.
- Microsoft Office Suite; Word, Excel, Google Chrome.
- Basic English.
- Basic mathematics.
Skill in:
- Effectively communicate verbally and in writing to resolve disputes with interested parties.
- Analyze moderately complex insurance, medical and legal documents.
- Review and interpret laws, rules, procedures, and court decisions.
- Strong critical thinking.
- Computer.
- Time management.
- Initiative and attention to detail.
- Strong focus on customer service.
- Strong organizational and planning skills.
Ability to:
- Interpret large and moderately 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.
- Recognize and engage those with different backgrounds, characteristics, and perspectives to bridge gaps in understanding of differing viewpoints, as well as ensuring persons with diverse perspectives are given the opportunity to collaborate and provide input.
- 3-5 years’ experience with Medical Only claims.
- Arizona Driver's License:
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
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.
