Claims Quality Assurance Specialist, Workers' Compensation

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 WCFs 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.

Position

• 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.

Qualifications

• Bachelors degree in business or related field preferred.
• At least five years of disability claims adjusting experience preferred.
• AIC designation preferred.
• 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.

WCF Insurance offers an extensive compensation package. Benefits include Medical Dental and Vision insurance company paid life insurance 401K with a generous 6% employer match and additional benefits such as an Employee Assistance Program (EAP) and time off to volunteer in the local community. All employees earn 4 weeks of vacation in their first year. Expected salary for this position is $80000 to $100000 depending on experience location and education. Expected salary for this position in Colorado and Nevada is $90000 to $110000. Expected hourly pay in California is $44 to $55.

An internal candidate should have six months in their current position acceptable job performance and must notify their current supervisor that they have applied for the position.

Our People

WCF strives to provide an excellent work experience and cultivate an inclusive environment where anyone who embodies our values will thrive

WCF Insurance is an Equal Opportunity Employer

WCF Insurance provides equal employment opportunity to all qualified applicants and employees regardless of race color religion sex age national origin veteran status disability that can be reasonably accommodated or any other basis prohibited by federal state or local law.

Required Experience:

IC