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Workers' Compensation Claims Audit Specialist
MSIG USAWorkers’ 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.
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
claims adjustingclaims auditauditingreserve adequacy assessmentmedical management evaluationstatutory benefits understandinglitigation practicessettlement practices
Soft Skills
attention to detailanalytical skillscommunication skillsreport writing
Tools & Technologies
claims systemsaudit toolsMicrosoft OfficeExcelWord
Certifications & Qualifications
adjuster license
Industry Keywords
workers’ compensationmulti-jurisdictional handlingdelegated authoritythird-party administratorscompliancefinancial integrityscoring criteria
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