[Hiring] Workers Compensation Auditor @Crawford & Company

Role Description

This is an exciting opportunity to join a global leader in claims management and make a meaningful impact through your expertise.

Ensures that clients receive a quality work product by adhering to the established standards and addressing deficiencies in both technical and file content areas.

Responsibilities

• Evaluates, calculates, processes and logs penalties for all CA offices.
• Seeks clarification on information submitted and evaluates legal issues or defenses applicable.
• Requires evaluation of documentation, data, time lines, potential legal issues and defenses.
• Pre-PAR and PAR auditing and preparation including ongoing auditing of claim files in preparation for the State's Division of WC audits.
• Requires clear communication of findings and instructions for claims corrections, plus management of responses/disputes from claims staff.
• Requires management of the process, tracking files involved and record keeping.
• Requires follow up to assure completion and documentation is completed.
• Coordinates, plans and confirms preparation of files for audit.
• Processes and audits benefit payment data to identify potential payments off schedule, payments issued late, possible need for penalties.
• Requires follow up and communication with claims staff throughout the state to assure completion on a regular schedule.
• Response to WCIRB PD Surveys - requires review and research of the file, verifying calculations, completing applicable forms.
• Response to claims handling questions, including questions on specific wage evaluation issues, questions about administration requirements, statutory or case law questions that affect administration, process questions, penalty questions, calculation questions.
• Triage or takeover processes.
• Program specific file reviews or assistance.
• Upholds the Crawford Code of Conduct.

Qualifications

• High school diploma required; Bachelor's degree preferred.
• Minimum 5 years experience with CA workers' compensation claims.
• Extensive adjusting experience, have CA Designations (equivalent of adjuster licensing), maintain CA adjuster CE requirements.
• Capable of evaluating those requirements at a high level equivalent to what State auditors do in their audits.
• Must have a CA Experienced Claims Adjuster Designation per 10 CCR 2592.
• Must complete continuing education requirements as outlined by Crawford Educational Services.

Requirements

• Must have a CA Experienced Claims Adjuster Designation per 10 CCR 2592.
• Documentation of maintaining Continuing Education requirements per that statute.
• Must complete continuing education requirements as outlined by Crawford Educational Services.

Benefits

• Competitive base pay.
• Bonus/Incentive Pay and other Performance-Based Rewards, if applicable.
• Medical, Dental and Vision Plans.
• Prescription Drugs.
• HSA, HRA, and FSA Accounts.
• Paid Holidays, Vacation and Sick Leave.
• 401(k) Retirement Plan.
• Tuition Assistance.
• Paid Parental Leave.
• Supplemental Health Benefits.
• Enhanced Mental Health Support.
• Virtual Physical Therapy.
• Caregiving Services.
• Life Assistance Program.