Premium Validation Program Analyst (Remote insurance role NE PA)

The Premium Validation Program Analyst plays an important role in PCRB’s ongoing efforts to modernize its premium validation and quality assurance programs. The position requires strong analytical skills, intellectual curiosity, and a commitment to continuous improvement. As PCRB expands its use of data analytics, automation, and artificial intelligence, the successful candidate will be adaptable, comfortable with evolving technology, and enthusiastic about identifying new ways to improve the accuracy, efficiency, and effectiveness of the program.

The Premium Validation Program Analyst works under the supervision of the Manager of Field Operations and is responsible for reviewing PA & DE carrier audits for compliance with manual rules, classification assignments, payroll allocations, claims, unit reports, pricing programs, and experience/merit ratings. The Analyst gathers information and verifies using Manual rules and standard premium auditing practices. This position supports PCRB’s responsibility to promote the accuracy, consistency, and integrity of workers’ compensation premium and classification data through independent review and quality assurance.

Essential Responsibilities:

• Analyze carrier-submitted premium audit data and supporting documentation to identify discrepancies, inconsistencies, potential errors, and opportunities to improve data quality.

• Review and analyze carrier audit worksheets, supporting documentation, and reported premium and exposure data for accuracy and compliance with applicable manual rules.

• Review and reconcile payroll, tax, accounting, and related financial records to verify remuneration inclusions, exclusions, and payroll allocations under applicable workers compensation rules, and accompanying accounting records for accuracy and compliance with workers’ compensation renumeration rules for inclusions and exclusions.

• Prepare comparative audit worksheets using employer payroll records and independent verification sources, document exceptions, discrepancies, and supporting evidence.

• Prepare clear, accurate, and well-supported reports describing business operations, employee duties, audit findings, and any recommended corrections.

• Prepare and submit all work assignments by established departmental deadlines. Maintain accurate electronic workpapers and complete records of review procedures, supporting documentation, and conclusions.

• Conduct special reviews and cross-functional projects supporting audit operations, Classification, data management, and other departments as assigned.

• Apply critical thinking and professional judgment to evaluate audit findings, identify recurring issues, and recognize patterns that may warrant further review.

• Support the ongoing modernization of PCRB’s premium validation program, including the development and refinement of data-driven review methodologies and quality assurance processes.

• Follow up consistently with employers to obtain additional information needed for review.

• Complete timely surveys for the Classification Department by conducting interviews with employers and utilizing various sources of data and related information.

• Conduct in person reviews when necessary based on audit complexity, program requirements, or management direction.

• Timely and consistent attendance.

Non - Essential Responsibilities :

• Provide accurate explanations of applicable audit and classification procedures to employers, agents, and carriers consistent with Bureau policies and assigned authority.

• Perform other miscellaneous duties as requested.

Requirements :

Education: Bachelor's degree in business or related field preferred. Professional designation (APA and/or CPCU) a plus

Experience : 2+ years of experience in premium auditing, insurance operations, accounting, insurance operations, compliance, data analysis, or a related analytical role. Experience reviewing and interpreting complex financial or insurance data, identifying discrepancies, and evaluating compliance with established rules or standards is desirable. Familiarity with workers’ compensation insurance is preferred.

Skills:

Strong analytical, investigative, reconciliation, and problem-solving skills, including the ability to identify discrepancies, evaluate information critically, and exercise sound professional judgment.

Strong organizational, communication, decision making, self-discipline, and written skills with the ability to work independently and adapt to various situations.

Effective professional communication with various internal and external stakeholders.

AI-curious, with a demonstrated interest in learning about artificial intelligence and its potential applications in improving business processes.

Demonstrated initiative, intellectual curiosity, and a continuous improvement mindset.

Technical competencies including Microsoft Office 365 . Communicate effectively with all levels of PCRB personnel and outside contacts. Must be able to manage multiple assignments and prioritize tasks accordingly.

Adaptable and receptive to new technologies, evolving processes, and innovative approaches to accomplishing work.