Performs audit of processes and claims for multi-jurisdictions and states to ensure that claims are handled in compliance with the best practices and procedures compliant with applicable state laws. Develop and deliver training programs for multi-jurisdictions and states.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Perform audit of processes and claims
Conducts financial and procedural claims audits based on various sampling methods.
Documents audit results and recommending quality improvement measures.
Generates monthly reports documenting overall statistical and financial errors.
Develops reports in order to successfully measure training needs and results.
Prepares information for California Workers Compensation Adjuster Certification Data Call.
Oversees and prepares responses to all audits whether internal or external.
Participates in CERT development, testing and audit.
Develop and deliver training programs
Develop and implement formal training programs and workflows for technical and non-technical positions.
Create and document internal protocols to ensure process and procedures changes are implemented across all impacted offices, appropriately documented, and compliant with all regulations.
EDUCATION AND EXPERIENCE
High school diploma or general education degree (GED).
A minimum of three years of technical Workers Compensation background is required.
Excellent verbal and written communication skills required. As well as time-management, good organizational skills, team oriented, great 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 organization. Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. 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.