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Workers' Compensation Audit & Compliance Specialist

Explorer Insurance
San Diego, CA
Full-time

Are you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hire innovative people who consistently adapt, grow and deliver.

We believe in hard work, a fun work environment, and embracing creativity that only comes about when talented people collaborate to develop solutions.

Our mission is to create the best insurance experience possible.

Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for seven consecutive years as a Top 50 performing P&C company offering the stability of a large, profitable and growing company combined with a small-company entrepreneurial spirit.

Our purpose-driven ethos provides team members with opportunities to contribute, develop, and belong.

The Workers' Compensation Audit & Compliance Specialist will perform audits of processes and claims for multi-jurisdictions and states.

This position exists to ensure that claims are handled in compliance with the best practices and procedures compliant with applicable state laws.

Candidates will be required to work a hybrid schedule if they live near one of following ICW Group's branch offices :

  • California - San Diego, Woodland Hills, Pleasanton, or Rancho Cordova
  • Lisle, IL
  • Wayne, PA
  • Lake Mary, FL
  • Las Vegas, NV
  • Round Rock, TX

WHAT YOU WILL DO

Conducts financial and procedural claims audits based on various sampling methods.

  • Documents audit results and recommends quality improvement measures.
  • Generates monthly reports documenting overall statistical and financial errors.
  • Prepares information for California Workers' Compensation Adjuster Certification Data Call.
  • Oversees and prepares responses to all audits whether internal or external.
  • Participates in Comprehensive Error Rating Testing (CERT) development, testing, and audit.

Develops workflows and implements training programs and workflows for technical and non-technical positions to ensure operational integrity.

  • Creates and documents internal protocols to ensure procedural changes are implemented across all impacted offices.
  • Ensures process and procedures changes are appropriately documented and compliant with all regulations.
  • Develops reporting to successfully measure training needs and results.

Designs and recommends compliance policies, processes and procedures for multi-jurisdictions states and municipalities.

  • Analyzes and manages incoming compliance audit requests including preparing response documents to ensure controls; makes recommendations for improvements.
  • Develops processes and workflows to maximize productivity and deliverables within hard deadlines.
  • Documents time spent on audits and facilitates with accounting team for billings associated therewith.

WHAT YOU BRING TO THE ROLE

  • High school diploma or general education degree (GED) required.
  • Minimum 3 years of technical Workers' Compensation background is required.

KNOWLEDGE AND SKILLS

  • Working knowledge of Workers' Compensation insurance principles and practices required.
  • Strong time-management, good organizational skills, sense of urgency, and attention to detail.
  • Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
  • Ability to write routine reports and correspondence.
  • Ability to speak effectively before groups of customers or employees of the organization.
  • Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
  • The ability to choose the right mathematical methods or formulas to solve a problem.

COMPENSATION

The current salary range for this position is $65,220.24 to $109,989.53. This range is exclusive of fringe benefits and potential bonuses.

If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate; including experience, education, and location of the role and considers employees performing substantially similar work.

WHY JOIN ICW GROUP?

  • Challenging work and the ability to make a difference
  • You will have a voice and feel a sense of belonging
  • We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
  • Bonus potential for all positions
  • Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year)
  • 10 paid holidays throughout the calendar year
  • Want to continue learning? We'll support you 100%

ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex / gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.

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