About this role
Role Overview
- Conduct audits of workers’ compensation claims administered under delegated authority by third-party administrators (TPAs).
- Evaluate the quality, accuracy, compliance, and financial integrity of delegated claims handling.
- Perform file-level and program-level audits applying standardized scoring criteria.
- Review medical management activities, assess reserve adequacy, and evaluate audit investigation quality.
- Document audit results in clear written reports with scoring and corrective recommendations.
Requirements
- 5+ years of workers’ compensation claims adjusting and/or claims audit experience.
- Demonstrated multi-jurisdictional WC handling knowledge across multiple states.
- Strong understanding of statutory benefits, reserving methodology, medical management, and litigation/settlement practices.
- Adjuster license(s) as required by applicable jurisdictions (or ability to obtain).
- Proficiency with claims systems, audit tools, and Microsoft Office (Excel, Word).
Benefits
- Equal employment opportunity (EEO)
- Reasonable accommodations for qualified individuals with disabilities