Regulatory AuditorDivision of Workers' Compensation/Self-Insurance UnitAnnual Salary Range: $47,115 - $53,962
Why you will love this position: The Division of Workers’ Compensation is looking for an applicant who enjoys working in a team environment, can maintain positive working relationships, and conducts duties with courtesy and respect. We’re looking for someone who works independently within the scope of assigned duties accepts and implements feedback with a positive attitude and constructively supports open communication, dedication, and compassion.
Self-Insurance Unit Mission Statement: “To serve as an underwriter to the Self-Insurers in the State of Missouri while providing support to fulfill their obligations to self-insure in the State of Missouri.”
What you will do: - Conduct audits of workers’ compensation self-inured employers’, group trusts’, and their third-party administrators' case handling to determine and ensure reporting and benefit payment compliance and the adequacy of case reserves and reserving practices.
- Research, review, and evaluate the program operations and activities of the third-party administrators, self-insured employers, and group trusts regarding workers' compensation injuries, claims, loss runs, and reserves for compliance with agency and program standards and Best Practices.
- Evaluate the impact of the self-insureds on the overall claims administration services provided, identify critical information relating to document submissions to the Division, and notify the self-insureds of compliance or noncompliance and corrective measures needed.
- Determine the appropriate action needed to comply with regulatory standards relating to case reserves, safety, payment of claims, and completion of document submissions to the Division.
- Evaluate the reliability of the insurance coverages, financials, accounting details, documentation supporting the reserves, medical determinations, payment of benefits to injured workers, and calculation of various benefit determination factors.
- Prepare formal, complete, and concise reports containing all pertinent audit observations, findings, evaluations, recommendations, and requirements.
- Educate current and prospective third-party administrators, self-insured employers, and group trusts about a compliance-related review's purposes, procedures, and obligations.
- Investigate complaints received by the Division in specific cases, review loss runs and documentation on bankrupt or liquidated companies, make sure all third-party contracts are up to date, review external sources as warranted by the situation, and write reports for disciplinary action to be taken by the Division against a non-compliant employer.
- Cross-train on the financial review aspects of self-insurance regulation, including evaluating income statements and balance sheets, performing a ratio analysis of company records emphasizing financial stability, solvency, loss reserves, liquidity, determining security requirements and the overall risk associated with the self-insured employer or group trust.
Qualifications - A bachelor’s degree from an accredited college or university with an emphasis in Business or Public Administration, Actuarial Science, Risk Management, or a closely related field OR 4 year of experience in insurance claims adjusting, auditing insurance claims, insurance regulation, contract review or analysis, risk management, or actuarial review
Lack of post-secondary education will not be used as the sole basis denying consideration to any applicant.
Desired Attributes - Must possess strong verbal and written skills.
- Knowledge of Missouri Workers' Compensation law and self-insurance regulations
- Experience adjusting workers' compensation cases.
- Knowledge/Experience with Microsoft Excel, Word, and Access.
- Experience using Insurance Claims Management Systems/Software
- One or more of the following designations or equivalent designations.
- Associate in Claims (AIC)
- Senior Claim Law Associate (SCLA)
- Workers’ Compensation Claims Professional (WCCP)
- Workers’ Compensation Claim Law Associate (WCLA)
- Workers’ Compensation Claim Law Specialist (WCLS)
- Certified Insurance Counselor (CIC)
- Certified Risk Manager (CRM)
- Associate in General Insurance (AINS)
- Associate in Risk Management (ARM)
More reasons to love this position: The State of Missouri offers an excellent benefits package that includes a defined pension plan, generous amounts of leave and holiday time, and eligibility for health insurance coverage. Your total compensation is more than the dollars you receive in your paycheck. To help demonstrate the value of working for the State of Missouri, we have created an interactive Total Compensation Calculator. This tool provides a comprehensive view of benefits and more that are offered to prospective employees. The Total Compensation Calculator and other applicant resources can be found here .
