Insurance Claims Processing Jobs in Phoenix, AZ (NOW HIRING)

Position Overview: This role combines high-level claims investigation and statutory oversight, focusing on complex determinations and the regulatory enforcement of bad faith and unfair claims processing pursuant to ARS 23-930. AAC R20-5-163.
The W/C Claims Adjuster 2 investigates, evaluates, and analyzes complex Workers' Compensation situations. This position serves as the primary lead for the Claims Division Bad Faith/Unfair Claims Processing Program, managing internal and externally filed complaints and handling the escalated process to completion. Responsibilities include issuing good faith and unfair claims processing practices awards, conducting complex audits and oversight and contributing to the divisional training programs. The role requires deep knowledge of the Arizona Workers' Compensation Act and modern claims handling best practices to ensure industry compliance and provide technical guidance.

This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures.

The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State's Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.

Essential Duties and Responsibilities include but are not limited to:
Bad Faith & Unfair Claims Processing Practices: Identify, review, and process all requests for 1061M, internal and external complaints regarding bad faith or unfair claims practices. Manage the escalated dispute process to completion, conduct audits, analyze trends, and compile data into formal reports for leadership.
Carrier Monitoring: Track payer claim status using Salesforce and other reporting software, make lifetime award determinations, and calculate average monthly wages or loss of earning awards. Enforce compliance efforts.
Audit & Compliance: Conduct Audits and complex research to proactively identify compliance issues. Make recommendations based on that research and develop internal and external programs to increase quality and compliance with existing Arizona WC laws, rules and statutes.
Training, Technical Guidance & Problem Solving: Provide training to internal & external customers, technical advice, guidance, and troubleshooting support to peers and internal teams regarding complex claim issues.
Support Annual Claims Seminar including updating the Claims Manual, creating and presenting dynamic presentation to community members.
Provide back-up assistance to awards, compliance, customer service, wage, data entry, no match or insurance, as requested.

Knowledge of
Comprehensive knowledge of Title 23, Chapter 6 of the ARS (Arizona Workers Compensation Act).
The Industrial Commission of Arizona Claims Division Operations.
Claims adjusting practices.
Excellent Knowledge of Microsoft Office, required. Google Suite and Salesforce, a plus.
Basic business english and mathematics.
Knowledge of using Internet based searching to conduct research.
Skill in:
Strong writing skills.
Effectively able to communicate verbally and in writing.
Strong reasoning and analytical skills.
Strong critical thinking and analysis.
Data interpretation.
Time Management.
Initiative and attention to detail.
Strong organization and planning skills
Strong customer service skills
Responsible for high-quality, nearly error-free output.
Ability to:
Understand and learn computer systems and applications.
Must demonstrate the ability to be use technology to problem solve, be a self learner in technology and continually enhance their skills in these areas to support our ongoing modernization momentum.
Ability to write technical instructions.
Interpret standard / simple claim files.
Conduct research and reach a logical conclusion based on results.
Manage heavy workload with high level of accuracy and production.
Work well within a diverse and inclusive office environment.
Timely process documents within established productivity standard and prioritize work within established time frames.
Manage time effectively and meet deadlines.
Adapt to changing circumstances.
Demonstrate initiative and attention to detail.
Exercise discretion and judgement.
Works well under pressure.
Ability to perform job responsibilities incorporating lean management and principles of the Arizona Management System.
Able to read and comprehend complex insurance, medical, and legal documents.

High School Diploma, Bachelors Degree or substitute with 5+ Year of Arizona Workers' Compensation Claims Handling

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

The Arizona Department of Administration offers a comprehensive benefits package to include:
Sick leave
Vacation with 10 paid holidays per year
Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
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

By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

Learn more about the Paid Parental Leave program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

You will be eligible to participate in the state employee health/disability insurance plan, and you are required to participate in the Arizona State Retirement System (ASRS). ASRS participation may begin immediately or upon your 27th week of employment. Contributions are matched by the employer.

If you have any questions, please feel free to call 602-542-5559 or email HR@azica.gov for assistance.