Compensation Insurance Specialist II

State of Colorado; Denver (CO); Hybrid; USD 39,000 - 55,000; Full time

Benefits offered by this job

PERA Defined Benefit Plan

PERA Defined Contribution Plan

401(k)

457 plan

Medical and dental health plans

Health Savings Account

Paid life insurance

Disability coverage

11 paid holidays

Wellness program

Flexible schedules

Employee affinity spaces

RTD EcoPass

Job summary

The State of Colorado seeks a Carrier Practices Auditor to audit claims handling by insurers and self-insured employers for compliance with the Workers’ Compensation Act and Rules. You will analyze data, issue findings, and recommend follow-up actions, including fines when necessary, while collaborating with insurers and legal teams.

Experience with statutes and case law interpretation plus the ability to manage multiple assignments is preferred. Hybrid work and formal training are provided.

Qualifications

• Five years of relevant experience in an occupation related to workers’ compensation claims.
• Experience handling or reviewing workers’ compensation claims with indemnity calculations and deadlines.
• Alternative: combination of related education and five years’ related experience.

Responsibilities

• Audit insurance carriers’ and self-insured employers’ claims administration for compliance with the Workers’ Compensation Act and Rules.
• Analyze audit results, prepare findings and recommendations, and draft orders for fines when needed.
• Interact with insurers and legal representatives and resolve complaints.

Skills

Workers' compensation experience

Claims auditing

Regulatory knowledge

Job description

THIS POSITION IS OPEN TO CURRENT RESIDENTS OF COLORADO ONLY

THIS ANNOUNCEMENT WILL REMAIN OPEN UNTIL 5:00 PM on TUESDAY, NOVEMBER 3, 2026

This position is Hybrid and will be required to report to the listed business address at the discretion of the supervisor and based on business need.

The Department of Labor and Employment keeps Colorado strong and competitive. We connect workers with great jobs and assist those who have been injured on the job. We help people who are unemployed through no fault of their own by providing temporary wage replacement and we ensure fair labor practices. We provide an up-to-date and accurate picture of the economy that helps in decision making. And we protect the workplace – and Colorado communities – with a variety of consumer protection and safety programs.

This is a values-driven organization, committed to accountability, agility, collaboration, and respect.

We believe in outstanding customer service, an inclusive culture, continued process improvement and in our role as a trusted and strategic partner. Recognizing that knowledgeable employees drive our success, we are seeking dedicated individuals who exhibit our shared values and our passion for quality and excellence in all we do.

In addition to rewarding and meaningful work, we offer excellent benefits:

• Strong, secure, yet flexible retirement benefits including a PERADefined Benefit Plan or PERA Defined Contribution Plan plus 401(k) and 457 plans

• Medical and dental health plans

• Employer supplemented Health Savings Account

• Paid life insurance

• Short- and long-term disability coverage

• 11 paid holidays per year plus vacation and sick leave

• BenefitHub state employee discount program

• MotivateMe employee wellness program

• Excellent work-life programs, such as flexible schedules, training and more

• Access to participate in employer-supported employee affinity spaces

• RTD EcoPass Commuter Program

• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information go to https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

Our agency website: Colorado Department of Labor and Employment

CDLE has implemented a pilot program on March 1st, 2022 which will award Disability Hiring Preference Points similar to the Veterans’ Preference Points program. During your application process you will be asked if you would like to be considered for either of these programs for additional points in the hiring process. To learn more about Disability Hiring Preference and what will be required to participate, please visit our website: https://sites.google.com/state.co.us/disability-hiring-preference/home

PLEASE NOTE: With the beginning of this program, CDLE will no longer accept attachments of any kind with applications. Please be as thorough as possible in documenting your education and work history in the application system. Attachments will not be accepted or considered during any phase of the hiring process including minimum qualification screening, comparative analysis, or interviews.

The salary range for this position is:

HOURLY

$28.59 - $40.13

BIWEEKLY

$2,286.92 - $3,210.62

MONTHLY

$4,955.00 - $6,956.34

The Carrier Practices unit examines and evaluates claims handling procedures of insurance companies through remote audits of claims files to determine levels of compliance with the Workers’ Compensation Act, rules of procedure, and applicable case law. The unit issues formal findings and recommendations relative to the audit and prepares fine orders for the Director for failure to comply with the Act and Rules.

A Carrier Practices Auditor in the Division of Workers’ Compensation Carrier Practices Unit audits insurance carriers’ and self-insured employers’ claims administration practices for compliance with the Workers’ Compensation Act and Rules of Procedure. The primary purpose for this position is to determine levels of compliance and state necessary measures when levels do not meet acceptable standards. The auditor analyzes data, issues preliminary findings, negotiates agreements, and issues final reports with summaries of deficiencies. A Carrier Practices Auditor analyzes audit results and comparative data to develop follow-up action and recommendation. Orders for fines are drafted for the Director’s signature when compliance levels are below standards set forth in Rule 4. This position interacts with insurers business and legal representatives, and investigates and resolves complaints.

Residency Requirement:

This posting is only open to residents of the State of Colorado at the time of submitting your application.

Class Code & Classification Description:

H6J3XX Compensation Insurance Specialist II

Minimum Qualifications:

Experience Only:

Five (5) years of relevant experience in an occupation related to the work assigned to this position to include: H andling or reviewing workers’ compensation claims which includes calculating indemnity benefit calculations, determining statutory and regulatory deadlines and applying applicable statutes, rules, or claim administration requirements.

Experience which is limited to completing Workers’ Compensation forms for submission but does not include the above duties and requirements will not be considered.

Or

Education and Experience:

A combination of related education and/or relevant experience in an occupation related to the work assigned equal to five (5) years

Preferred Qualifications:

• Experience researching and interpreting statutes, regulations, or case law; documenting findings;and communicating or resolving disputed conclusions
• Experience reviewing detailed records, analyzing information, and preparing written documentation.
• Ability to organize and manage multiple assignments, prioritize competing deadlines, and maintain accuracy.
• Experience interpreting and applying Workers’ Compensation Rules 5,6, and 7
• Experience performing similar duties as a State of Colorado classified employee.

Conditions of Employment:

• Must be a Colorado resident at time of application.
• You must pass a thorough background check prior to employment to include the E-Verify process.

Appeal Rights:

As an applicant who has been removed from consideration during the selection or comparative analysis process, you may file an appeal with the State Personnel Board and/or request a review by the State Personnel Director. A standard appeal form is available on the State Personnel Board website, https://spb.colorado.gov/forms-and-filing. If you appeal, your appeal must be submitted in writing on the official appeal form, signed by you or your representative, and received at the following address within ten (10) days of your receipt of this notice: Colorado State Personnel Board/State Personnel Director, Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, CO 80203. Fax: [phone]. Phone: [phone]. Email address: [e-mail]. The ten-day deadline and these appeal procedures also apply to all charges of discrimination. Refer to Chapters 4 and 8 of the State Personnel Board Rules and Personnel Director’s Administrative Procedures, 4 CCR 801, for information about the appeals process. The State Personnel Board Rules and Personnel Director’s Administrative Procedures are available at spb.colorado.gov.

For questions regarding this recruitment, please contact:

[e-mail]

Minimum Qualification Screening

A Human Resources Analyst will only review the work experience/job duties sections of the online job application to determine whether you meet the minimum qualifications for the position for which you are applying. Cover letters and resumes WILL NOT be accepted in lieu of the official State of Colorado online application, CDLE does not accept attachments of any kind during the application process. Part-time work experience will be prorated.

Comparative Analysis Process

After minimum qualification screening, the comparative analysis process