Claims Quality Assurance Specialist, Workers' Compensation
About The Position
WCF is an A-rated insurance carrier growing in the western U.S. We are looking to add a claim professional wanting to join a company with a great culture, competitive pay and great benefits. We work hard to attract and retain the best people to provide leading edge service to our customers. To this end, we have developed a competitive benefit program, work/life program and personal/professional development. Our growth will provide great advancement opportunities. WCF believes the most effective representative results from a great work environment with a healthy life outside of work. Our Claims department has an immediate opening for someone who can demonstrate WCF Insurance values to join their team as a Claims Quality Assurance Specialist, Workers' Compensation. This full-time position is open to external and internal candidates. The person in this position works out of the WCF's Sandy, Utah headquarters or one of the regional offices located in Roseville, CA; Boise, ID; or Denver, CO. Hybrid (office/home) or remote option is available.
Requirements
- Bachelor's degree in business or related field preferred.
- At least five years of senior-level disability claims adjusting experience.
- Advanced understanding of the Workers' Compensation Act, Labor Commission rules and regulations, Fair Claims Practices Act, applicable case law, and other relevant standards.
- Knowledge of general liability, insurance industry principles, injury types, including appropriate medical care and related medical procedures.
- Demonstrated knowledge of claims and claims processes.
- Effective written and oral communication, analytical, decision-making, and interpersonal skills.
Nice To Haves
- AIC designation preferred.
Responsibilities
- Perform quality assurance audits on disability and medical claim files in multiple jurisdictions to ensure the performance standards and best practices of the claims department are met.
- Perform quality assurance audits on all claims functions including subrogation, fraud, case management, and bill review.
- Document findings and communicate results of audits to the appropriate employee, managers, and claims VP.
- Provide reports and statistics to measure the quality of service provided.
- Ability to work independently and manage multiple priorities.
- Conduct audits of workers' compensation claims for accuracy, compliance, and adherence to company policies and regulations.
- Identify trends, errors, and opportunities for improvement in claims handling processes.
- Prepare detailed audit reports and communicate findings to management and claims teams.
- Stay current with state workers' compensation laws and industry best practices.
- Promote excellent customer service.
Benefits
- Medical, Dental, and Vision insurance
- company paid life insurance
- 401K with a generous 6% employer match
- Employee Assistance Program (EAP)
- time off to volunteer in the local community
- All employees earn 4 weeks of vacation in their first year
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
