Insurance Claims Specialist 2

Title: Insurance Claims Specialist 2

Location: PHOENIX

Job Description:

W/C INSURANCE CLAIMS SPECIALIST 2

Job Location:

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

Posting Details:

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 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.

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 HR@azica.gov for assistance.