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