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.
Skills Required
Knowledge of:
Skill in:
Ability to:
Experience Required
High School diploma, 5+ years of customer service experience and/or workers compensation insurance.