WCF Insurance · 2 days ago
Claims Quality Assurance Specialist, Workers' Compensation
Sandy, UT
Full-time
Hybrid
Mid, Senior Level
$80K/yr - $100K/yr
5+ years expWCF Insurance is an A-rated insurance carrier growing in the western U.S. They are seeking a Claims Quality Assurance Specialist to perform quality assurance audits on disability and medical claim files, ensuring compliance with performance standards. The role involves documenting findings, identifying trends, and providing reports to enhance claims handling processes.
InsuranceNon Profit
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
Qualification
Required
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
Preferred
Bachelor's degree in business or related field
At least five years of disability claims adjusting experience
AIC designation
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
4 weeks of vacation in their first year
Company
WCF Insurance
WCF Insurance is an NGO that assists in insurance claims, online resources, safety services, managed-care and fraud services to workers.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Matt Lyon
Chief Executive Officer and President
Bill Riedley
VP/CUO Small Business
Recent News
Coverager - Insurance news and insights
2025-01-09
Coverager - Insurance news and insights
2024-11-07
Company data provided by crunchbase