Insurance Claims Compliance Specialist
2 weeks ago
Position Overview:
This role involves the meticulous examination of incoming claims documentation to ensure adherence to relevant workers' compensation claims management regulations, statutes, and legal precedents.
Remote work opportunities may be available within Arizona, contingent upon departmental requirements and consistent achievement of performance benchmarks.
The State of Arizona is committed to fostering a work environment that promotes flexibility, independence, and trust. Many employees across various state agencies participate in the Remote Work Program, allowing them to work from home, shared offices, or designated hoteling spaces. All work, including remote tasks, should be conducted within Arizona unless a prior exception is duly authorized.
Key Responsibilities:
Essential duties include, but are not limited to:
- Conducting thorough analyses of submitted forms for compliance and issuing appropriate determinations when warranted.
- Auditing claims managed by insurance carriers, self-insured entities, and third-party administrators.
- Reviewing notifications and accompanying medical documentation to ensure they substantiate any changes in status or calculations of wages and awards. Following analysis, the specialist will issue the correct corresponding award or notification.
- Responding to incoming inquiries from injured workers, legal representatives, claim adjusters, medical professionals, and the public.
- Linking documents that lack information to existing claims files by researching the Claims database and creating new claim files as necessary.
- Providing support for data entry, error resolution, and other tasks as requested.
- Participating in the Arizona Management System (AMS) and daily team meetings.
- Attending staff meetings, workshops, conferences, and training sessions.
Knowledge, Skills & Abilities:
Required knowledge includes:
- Understanding of applicable workers' compensation claims management laws and regulations.
- Familiarity with basic medical terminology.
- Proficiency in Microsoft Office Suite and Google Office Suite.
- Basic English and Mathematics skills.
- Knowledge of insurance industry standards and practices.
Skills required include:
- Effective verbal and written communication for dispute resolution.
- Analytical skills for reviewing insurance, medical, and legal documents.
- Critical thinking and time management abilities.
- Customer service orientation and organizational skills.
Abilities required include:
- Interpreting medical records to assess physical limitations.
- Managing a heavy workload with precision and efficiency.
- Learning new computer systems and applications.
- Adapting to diverse and inclusive work environments.
- Processing documents promptly and within productivity standards.
Preferred Qualifications:
The ideal candidate will possess:
- A claims adjusting license or relevant certification in workers' compensation.
Pre-Employment Requirements:
All newly hired State employees must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
Benefits:
The Arizona Department of Administration provides a comprehensive benefits package, including:
- Sick leave
- Vacation time with 10 paid holidays annually
- Health and dental insurance
- Retirement plan
- Life insurance and long-term disability coverage
- Optional benefits such as short-term disability insurance and deferred compensation plans
Offering both full-time and part-time remote work options, employees can achieve a better work/life balance, leading to increased job satisfaction and productivity. Remote work arrangements are at the discretion of management and not guaranteed.
Retirement:
Employees are eligible to participate in the state employee health and disability insurance plan and must enroll in the Arizona State Retirement System (ASRS), with contributions matched by the employer.
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