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Job Information
Job Title:  WORKERS' COMP SENIOR CLAIMS ADJUSTER 
Agency:  DEPARTMENT OF ADMINISTRATION 
Job Reference ID:  58626 
Category:  INSURANCE/BANKING 
Grade:  24 
Posted Date:  11/05/2020 
Close Date:  11/04/2020 
Job Description




Arizona Department of Administration

Delivering results that matter by providing best in class support services.

ARIZONA MANAGEMENT SYSTEM (AMS)

All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress.  Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results.  State employees are highly engaged, collaborative and embrace a culture of public service. 


Workers’ Compensation Sr. Claims Adjuster

Risk Management Division

100 N. 15th Avenue, Suite 301

Phoenix, AZ 85007

www.azdoa.gov

JOB SUMMARY:

The Workers’ Compensation Sr. Claims Adjuster will be responsible for certifying or non-certifying medical care, supplies, evaluations, consultations, independent medical reviews, durable medical equipment, case management activities, private investigator activities, litigation activities, disability benefits, loss of earning capacity benefits, scheduled impairment ratings, and supportive care while managing Arizona worker’s compensation indemnity claims. This position will investigate, evaluate, and analyze worker’s compensation claims against the State and determine appropriate resolutions of claims, and will also negotiate settlements directly with plaintiff or counsel within authority level established by state statute, rules, policies, and procedures. Additional responsibilities will include to identify, investigate, and pursue subrogation recoveries from negligent third parties, identify loss exposures to the State and communicate with appropriate State agency personnel and Risk Management Loss Prevention, and establish individual and accurate claim reserves. Lastly, the person in this position will consult with and advise agency management and key personnel of losses that may impact their operations, provide assistance and technical advice to state agency staff and the public relative to claims reporting requirements, maintain claim files, provide file documentations as dictated by policies and procedures, maintain accurate, current, and complete claim information databases, and coordinate claims with the Office of the Attorney General, as needed. 

In addition, this person will mentor, train, assign, monitor, oversee, and evaluate activities of Entry adjusters and/or investigators.

JOB DUTIES:

  • Investigate, evaluate, analyze, and determine compensability of catastrophic claims

  • Calculate average monthly wage and set reserves

  • Compute and authorize indemnity and medical benefits; update claims system; negotiate settlements, and notify the respective agency loss prevention coordinator of risks

  • Monitor changes to diagnosis to verity ICD codes are current for Medicare purposes 

  • Coordinate activities of nurse case managers, claim specialists, attorney and/or subrogation specialists, and with other RMD sections as appropriate

  • Identify the need for and coordinate Independent Medical Examinations (IME’s)

  • Communicate with agency personnel and injured employees, conduct claims management training and claim review, as needed

  • Exercise independent judgement of complex claims and functions, as directed

  • Proper management of litigation working with Attorney General’s Office or outside counsel, experts, and plaintiff counsel

  • Visit agencies; attend staff/huddle meetings, professional development trainings, seminars, and conferences

  • Oversee performance of contracted vendors and experts to assist in claim management, such as labor mark consultants, nurse case managers, investigators, and IME coordination services

  • Complete other projects as assigned to produce positive and measurable results

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

Knowledge of:

  • Arizona’s Workers’ Compensation laws, rules, and regulations

  • Medical and insurance terminology

  • Arizona Industrial Commission fee schedule

  • Information systems for claims management

  • Various types of insurance, insurance contracts, and related law

  • Administrative policies, practices, procedures, and research methods

  • Occupational, safety, and health regulations

  • Insurance claims processing

  • Alternative Dispute Resolution

  • Medical terminology, best practices, disability guidelines, and risk factors

Skill in:

  • Planning, organizing, inperpretting, and analyzing medical reports, disability statements, earnings reports, case management reports, litigation outcomes, apportionment, disability guidelines, impairment ratings, labor market surveys, and loss of earning capacity evaluations

  • Evaluation, analysis, and decision making

  • Comparing fee schedule codes for accuracy

  • Identifying and resolving problem medical claims

  • The use of personal computers and programs, such as Google Suite

Ability to:

  • Provide excellent customer services and maintain excellent interpersonal relations

  • Communicate effectively through oral, written, and electronic means

  • Maintain composure in emotionally charged situations

  • Interpret and apply statues, rules, policies, and procedures of State government

  • Maintain confidentiality and report status of investigations and research

  • Recognize and evaluation potential hazards, make appropriate recommendation, and influence decisions that will result in a reduction of exposures

  • Receive and understand complex data

  • Investigate and evaluate facts relating to claims

  • Negotiate and settle claims within authority level

  • Manage varied responsibilities with accuracy and speed under the pressure of time sensitive deadlines


SELECTIVE PREFERENCE:

  • Minimum of three years experience managing Arizona workers’ compensation indemnity claims

  • Proficient in Google Suite

PRE-EMPLOYMENT REQUIREMENTS:

  • Valid Arizona Drivers License

BENEFITS:

The Arizona Department of Administration offers a comprehensive benefits package to include: 

  • Sick leave

  • Vacation with 10 paid holidays per year

  • Health and dental insurance

  • Retirement plan

  • Life insurance and long-term disability insurance

  • Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance

RETIREMENT:

  • Positions in this classification participate in the Arizona State Retirement System (ASRS). 

  • Please note, enrollment eligibility will become effective after 27 weeks of employment.

CONTACT US:

  • If you have any questions please feel free to contact Shelia Wiggins-Wayne at [email protected] or 602-542-4769 for assistance.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting INSERT CONTACT NAME AND CONTACT INFO HERE. Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.


 
Position Requirements
Position Level:    Hours:   
 Work Arrangement:     Employment Type:   
Hourly Rate:  $0.00 / per hour  Salary: 

 

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