W/C Indemnity Adjuster
2 weeks ago
Job Location: Phoenix, AZ, 85007
Shift Hours: 06:00 AM to 06:00 PM
Work Mode: Onsite
Candidate Location: Only local to Arizona
Position Description: 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 Huddleboard. 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
Skills Preferred:
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
Experience Preferred:
Education 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
Education Preferred:
Additional Information:
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