Compensation Insurance Specialist II

State of Colorado•Denver, CO

1d•Hybrid

About The Position

The Carrier Practices Unit examines and evaluates insurance companies’ claims-handling procedures through remote audits of claims files to determine compliance with the Workers’ Compensation Act, rules of procedure, and applicable case law. The unit issues formal audit findings and recommendations and prepares fine orders for the Director when carriers fail to comply with the Act and Rules. The Compensation Insurance Specialist II serves as a Carrier Practices Auditor in the Division of Workers’ Compensation. The position audits insurance carriers’ and self-insured employers’ claims-administration practices, determines compliance levels, and identifies measures needed when standards are not met. The auditor analyzes data, issues preliminary findings, negotiates agreements, prepares final reports summarizing deficiencies, and develops follow-up actions and recommendations based on audit results and comparative data. Fine orders are drafted for the Director’s signature when compliance falls below standards set forth in Rule 4. The position also interacts with insurers’ business and legal representatives and investigates and resolves complaints. This hybrid position is open only to Colorado residents. The supervisor may require the employee to report to the listed business address based on business needs. The posted salary range is $28.59–$40.13 per hour, $2,286.92–$3,210.62 biweekly, or $4,955.00–$6,956.34 monthly. A thorough background check, including E-Verify, is required before employment.

Requirements

At least five years of relevant experience handling or reviewing workers’ compensation claims, including calculating indemnity benefits, determining statutory and regulatory deadlines, and applying applicable statutes, rules, or claim-administration requirements; or a combination of related education and/or relevant experience equal to five years.
Must be a Colorado resident at the time of application.
Must pass a thorough background check prior to employment, including the E-Verify process.

Nice To Haves

Experience researching and interpreting statutes, regulations, or case law; documenting findings; and communicating or resolving disputed conclusions.
Experience reviewing detailed records, analyzing information, and preparing written documentation.
Ability to organize and manage multiple assignments, prioritize competing deadlines, and maintain accuracy.
Experience interpreting and applying Workers’ Compensation Rules 5, 6, and 7.
Experience performing similar duties as a State of Colorado classified employee.

Responsibilities

Audit insurance carriers’ and self-insured employers’ claims-administration practices for compliance with the Workers’ Compensation Act and Rules of Procedure.
Analyze audit data and comparative results to determine compliance levels and identify necessary measures when standards are not met.
Issue preliminary findings and negotiate agreements.
Prepare final audit reports summarizing deficiencies.
Develop follow-up actions and recommendations based on audit results and comparative data.
Draft orders for fines for the Director’s signature when compliance levels are below standards set forth in Rule 4.
Interact with insurers’ business and legal representatives.
Investigate and resolve complaints.

Benefits

PERA Defined Benefit Plan or PERA Defined Contribution Plan, plus 401(k) and 457 plans
Medical and dental health plans
Employer-supplemented Health Savings Account
Paid life insurance
Short- and long-term disability coverage
11 paid holidays per year, plus vacation and sick leave
State employee discount program
Employee wellness program
Flexible schedules and training
RTD EcoPass Commuter Program
Some positions may qualify for the Public Service Loan Forgiveness Program