CA Workers Compensation Claims Auditor TempRemote

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

• 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.

• 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 employers discretion.

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