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Workers' Compensation Claims Audit Specialist
Job in
Cincinnati, Hamilton County, Ohio, 45208, USA
Listed on 2026-08-02
Listing for:
Jobtailor
Full Time
position Listed on 2026-08-02
Job specializations:
-
Insurance
Risk Manager/Analyst, Insurance Claims
Job Description & How to Apply Below
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.
- 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).
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