CA Workers Compensation Auditor (Finance)

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

• 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 and capable of evaluating those requirements at a high level equivalent to what State auditors do in their audits. Capable of teaching, training, communicating and exerting direction on claims consistent with CA requirements.
• Must have a CA Experienced Claims Adjuster Designation per 10 CCR 2592 as well as documentation of maintaining Continuing Education requirements per that statute
• Must complete continuing education requirements as outlined by Crawford Educational Services

#LIEM3

• 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 completed 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.