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.