Full time, Contract | Phoenix, Arizona
SunSoft Online
Status: Active
Posted On: Sep 17 2023
Salary: $40000 - $51000 per year


Requisition #691

Roles & Responsibilities

  • This position will be 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 journey level professional claims management of the following status’: time loss, permanent impairment, permanently awarded (as defined by a Loss of Earning Capacity award and/or Supportive care), apportionment and vocational rehabilitation.
  • Employees work under supervision and exercises independent judgment within established guidelines and procedures.
  • Provides high quality and timely customer service to internal and external customers, building a professional relationship.
  • Responsible for performing work of considerable complexity associated with workers compensation claims processing inclusive of timely processing of claims;
  • Reviews, analyzes and proactively manages workers compensation claims to ensure legal and timely benefits.
  • Analyzes and applies advanced concepts of the following: internal Best Practices standards, Occupational Disability Guidelines, Arizona Workers Compensation laws, rules and case law decisions, Arizona Fee schedule.
  • Conducts claims investigations, assigns cases for additional investigation; Analyze, investigate, and complete compensability decisions on time loss (indemnity) claims. 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.
  • Completes independent medical examinations as indicated.
  • Evaluates claim value for settlement and negotiates simple to complex settlements.
  • 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.
  • Establishes Average Monthly Wage.
  • Authorizes compensation and medical benefits, including Loss of Earning Capacity, Fatality and Apportionment reimbursements.
  • Responsible for timely processing of claims scheduling and prioritizing work within established time frames.
  • Provides technical assistance.
  • Participates in Arizona Management System (AMS) and daily claims Huddle board.
  • Attend staff meetings, as indicated.

Skills Required

  • Strong verbal and written communication skills.
  • Dispute resolution.
  • Analyzing insurance, medical and legal documents of moderate to high complexity to reach logical claims determinations.
  • Reviewing, interpreting and applying laws, rules, procedures and court decisions.
  • Strong critical thinking skills.
  • Computer usage.
  • Time Management.
  • Initiative and attention to detail.
  • Strong focus on customer service
  • Strong organizational and planning skills.

Experience Required

  • Knowledge in : Arizona workers’ compensation statutes, rules of procedure, regulations, Court of Appeals and Supreme Court decisions regarding workers’ compensation law.
  • Workers' compensation claims processing procedures and best practices.
  • Federal and State vocational rehabilitation laws.
  • Medical terminology and treatment protocols, and Occupational Disability Guidelines.
  • Insurance and legal terminology
  • Microsoft Office Suite; Outlook, Word, Excel, Google Chrome.
  • Basic English
  • Basic Mathematics.