About the Opportunity

Our client, a well-established workers' compensation organization, is seeking an experienced, temporary, Workers' Compensation Claims Auditor to join their team. This fully remote opportunity is available to candidates who reside in California and possess a strong background in California workers' compensation claims handling and quality assurance.

This position is responsible for conducting comprehensive audits of claim files to ensure compliance with California workers' compensation regulations, internal best practices, client service standards, and organizational guidelines. The ideal candidate is highly analytical, detail-oriented, and passionate about driving continuous improvement in claims quality and operational excellence.

Compensation:

• Fully remote work environment (California residents only)
• $50.00 - $55.00/hr.
• Comprehensive medical, dental, and vision insurance

Qualifications

• 7+ years of California Workers' Compensation claims handling experience.
• 2+ years of claims auditing, quality assurance, technical review, or supervisory experience preferred.
• Extensive knowledge of California Workers' Compensation statutes, regulations, and claims administration.
• Experience auditing indemnity and medical-only claims of varying complexity.
• Strong understanding of:
  • Benefit delivery
  • Reserving practices
  • Litigation management
  • Medical management
  • Settlement evaluation
  • Compliance standards
• Exceptional written and verbal communication skills.
• Strong analytical and organizational abilities.
• Experience using electronic claims management systems.
• Proficiency with Microsoft Office Suite, particularly Excel.

Responsibilities

• Conduct quality assurance audits of California workers' compensation claim files across multiple claim levels.
• Evaluate claim handling for compliance with California Labor Code, regulations, client-specific requirements, and company best practices.
• Review reserves, compensability decisions, benefit administration, medical management, settlement strategies, and documentation.
• Identify trends, strengths, deficiencies, and opportunities for process improvement.
• Prepare detailed audit reports with scoring, findings, and actionable recommendations.
• Present audit results to claims leadership and provide coaching feedback to adjusters and supervisors.
• Monitor corrective action plans and follow-up on identified improvement opportunities.
• Assist in developing audit standards, scorecards, and quality metrics.
• Stay current on California workers' compensation laws, regulatory changes, and industry best practices.
• Participate in quality improvement initiatives, training programs, and operational projects.

 

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer’s discretion.

 

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