This position of the Workers Compensation is responsible for auditing claims documents for compliance with applicable workers compensation claims management laws, statutes, and case laws. This position will 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 Average Monthly Wage. This job involves moderate amount of customer contact and repetitive review of recommended average monthly wage forms, performing review of calculations using internal software and tools to assist and approving/denying the request. After analysis, the Specialist will issue correct corresponding award, notification, or document; answer incoming phone calls from injured workers, attorneys, interested parties, claim adjusters, medical providers, and 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 compliance, data entry, error resolution, no match or combine/delete as requested; participates in Arizona Management System (AMS) and daily Huddle board; attend staff meetings, seminars, conferences, training classes as required.
- Basic knowledge or ability to learn applicable workers compensation claims management laws, statutes, case laws.
- Basic Medical terminology.
- Microsoft Office Suite; Outlook, Word, Excel.
- Basic English and Basic Mathematics
- 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 and 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 skills.
- 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.
High School diploma, 5+ years of customer service experience and/or workers compensation insurance.