Technical Specialist, Premium Audit

San Diego, California

 

PURPOSE OF THE JOB

The purpose of this job is to serve as the technical expert to the Audit Department through conducting complex audits, investigating fraud, and resolving high level disputes. This job exists to provide guidance to all ICW personnel and to ensure that audits are performed accurately and thoroughly.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Conducts field audits to determine the actual exposures and premium to be charged for policy coverages.

  • Prioritizes audit assignments and conducts audits achieving both volume and quality standards.
  • Works with high value customers and performs on site premium audits for applicable complex and large accounts.
  • Corresponds with insureds, agents, and Company personnel on field audit procedures and results.
  • Assists to resolve high profile/complex audit disputes, making certain the insured, agent (when applicable), legal teams, and collection department are informed of the outcome.
  • Works with Direct Collections department to assist in resolving issues.

Serves as Field Premium Audit Subject Matter Expert to Premium Audit Department.

  • Maintains all field audit reference materials and manualsensuring all regulatory and statutes are up to date.
  • Provides guidance and expertise to field team members about audit questions or technical issues.
  • Assists with training of new team members as requested.

Provides technical expertise to other constituencies.

  • Communicates with National Council on Compensation Insurance (NCCI), Workers Compensation Insurance Rating Bureau (WCIRB), and other state bureaus on classification and technical issues.
  • Works with the inside audit team to respond to queries and test audit errors from the various Workers' Compensation bureaus.
  • Assists management with training information for auditors as a result of a test audit error.
  • Works with fee audit companies, as necessary.
  • Assists Underwriting and agents with classification questions and issues.
  • Reviews requests from Premium Recovery companies to ensure that the proper authorizations are present and the audit is approved to send out.

Performs premium fraud investigations, including grand jury and trial testimony.

  • Reviews and investigates suspected fraud from referrals.
  • Collaborates with management and Special Investigations Unit (SIU) personnel to prosecute and convict.
  • Provides expertise and guidance to field auditors in the identification of fraud and provides regular updates and education on recognizing fraudulent activity.
  • Acts as the liaison between the SIU and Premium audit to determine what will be reported.
  • Acts as the liaison between legal and Premium audit.
  • Provides expert testimony as needed.

SUPERVISORY RESPONSIBILITIES

This role does not have supervisory responsibilities.

EDUCATION AND EXPERIENCE

Bachelor's degree from four-year college or university preferred with a major or emphasis in Business Administration, Accourning or related field. Minimum 7-10 years of related premium audit experience and/or training; or equivalent combination of education and experience.

CERTIFICATES, LICENSES, REGISTRATIONS

Valid Driver's License by local state authority required. Associate in Premium Auditing (APA), or Chartered Property Casualty Underwriter (CPCU), or CIPA certifications preferred.

KNOWLEDGE AND SKILLS

Working knowledge of field premium auditing required. Required expert knowledge of proper audit techniques and standards of audits. Must understand and be able to apply Workers Comp audit principles within different jurisdictions and have a good working knowledge of Work Comp, General Liability and Automobile/Garage Liability. Must be proficient in Microsoft Office Suite and have working knowledge of a variety of payroll and accounting systems. Must be able read, analyze and interpret technical journals, financial information, or legal documents. Basic to intermediate business mathematical skills including the ability to calculate rates, ratios, and percent and to interpret financial data and draw conclusions. Ability to effectively communicate technical and financial information verbally. Must have demonstrated presentation skills.

PHYSICAL REQUIREMENTS

Position requires frequent travel up to 30%. In conducting audits and performing other tasks, works with computers and computer screens for multiple hours per day; must be able to lift and carry 25-40 pounds. Position is sedentary approximately 70% of time. Must be able to drive and be comfortable working independently.

COMPETENCIES

This position maps to the Individual Contributor level.

WORK ENVIRONMENT

This job is a combination of working from home and working in the insureds clerical office areas. Requires travel (driving and flying) to insureds locations to conduct audits. Customer worksites may vary in the environment.