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W/C CLAIMS ADJUSTER 2

Job Location:

Special Fund Division

Address:  800 W Washington St., Phoenix Arizona

Posting Details:

Hourly: $27.1409 -$35.00

Grade: 20

Closing Date:  January 16, 2026

Job Summary:

This position is 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 and Vocational Rehabilitation claims.

Job Duties:

File handling of expert 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), and vocational rehabilitation. Caseload will be of high complexity, involving catastrophic claims. Employee works under supervision and exercises independent judgment within established guidelines and procedures.

Other duties include but are not limited to: providing high quality and timely customer service to internal and external customers, building a professional relationship; performing work of large loss/catastrophic complexity associated with workers' compensation claims processing inclusive of timely processing of claims; reviewing, analyzing and proactively managing workers compensation claims to ensure legal and timely benefits; analyzing and applying advanced concepts of the following; internal Best Practices standards, Occupational Disability Guidelines, Arizona Workers' Compensation laws, rules and case law decisions, Arizona Fee schedule; conducting claims investigations, assigns cases for additional investigation; identifying claims with subrogation potential; critically reviewing medical reports to determine change in claim status and maximizes opportunities for claim management interventions; reviewing and authorizing medical bills; completing independent medical examinations as indicated; evaluating claim value for settlement and negotiates simple to complex settlements; developing and maintaining reserves and plan of action to manage the claim to resolution; exercising independent judgment within established authority levels; initiating contact with claimants, employers, attorneys, or medical providers; establishing Average Monthly Wage; authorizing compensation and medical benefits; including Loss of Earning Capacity and Fatality reimbursements; and responsible for timely processing of claims scheduling and prioritizing work within established time frames.

Knowledge, Skills & Abilities (KSAs):

Knowledge of:
• 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
• Google Suite, Microsoft Office, Salesforce including the Community Portal.
• Basic English
• Basic Mathematics

Skill in:
• 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

Ability to:
• Interpret catastrophic & complex claim files.
• Manage heavy workload with high level of accuracy and production.
• Learn computer systems and applications.
• Work well within a diverse and inclusive office environment.
• Manage time effectively and meet deadlines.
• Adapt to changing circumstances.
• Demonstr