California Workers' Compensation Auditor

Job Summary

To ensure compliance with regulatory standards and improve claims quality, the remote Senior Claims Quality Assurance Auditor will conduct audits of claims handling processes, review claim files, and prepare detailed reports while collaborating with various teams.

Key responsibilities

• Conduct regular audits and assessments of claims handling processes to verify compliance with regulatory standards and internal guidelines
• Document audit findings and prepare comprehensive reports that include recommendations for corrective actions
• Collaborate with multiple departments to develop and update quality control policies based on audit findings

Required qualifications

• High School diploma or GED required; Bachelor's degree in Business Administration, Risk Management, or related field preferred
• 8+ years of workers' compensation claims experience with a strong understanding of claim handling practices
• 3+ years of experience in claims auditing, quality assurance, or compliance roles preferred
• Minimum of 2 years of California workers' compensation claims experience required
• Strong knowledge of Claims Best Practices and regulatory requirements across multiple jurisdictions