Workers Compensation Claims Specialist

Responsibilities 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 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). #J-18808-Ljbffr