Workers' Compensation Claims Audit Specialist

MSIG USA

Workers’ Compensation Delegated Claims Audit Specialist evaluating claims handled by third-party administrators. Conducting audits, ensuring accuracy, compliance, and financial integrity in workers' compensation claims management.

Posted 6/26/2026full-timeCincinnati • Ohio • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Conduct audits of workers’ compensation claims administered under delegated authority by third-party administrators (TPAs).
Evaluate the quality, accuracy, compliance, and financial integrity of delegated claims handling.
Perform file-level and program-level audits applying standardized scoring criteria.
Review medical management activities, assess reserve adequacy, and evaluate audit investigation quality.
Document audit results in clear written reports with scoring and corrective recommendations.

Requirements

What you’ll need

5+ years of workers’ compensation claims adjusting and/or claims audit experience.
Demonstrated multi-jurisdictional WC handling knowledge across multiple states.
Strong understanding of statutory benefits, reserving methodology, medical management, and litigation/settlement practices.
Adjuster license(s) as required by applicable jurisdictions (or ability to obtain).
Proficiency with claims systems, audit tools, and Microsoft Office (Excel, Word).

Benefits

Comp & perks

Equal employment opportunity (EEO)
Reasonable accommodations for qualified individuals with disabilities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims adjustingclaims auditauditingreserve adequacy assessmentmedical management evaluationstatutory benefits understandinglitigation practicessettlement practices

Soft Skills

attention to detailanalytical skillscommunication skillsreport writing

Certifications

adjuster license