Workers' Compensation Claims Audit Specialist

Jobtailor; Cincinnati (OH); On-site; USD 65,000 - 90,000; Full time

Job summary

Jobtailor in Cincinnati seeks an experienced Workers’ Compensation Claims Auditor to ensure quality and compliance across delegated claims handling.

You will evaluate reserves, medical management, and settlements, conduct file- and program-level audits, and report findings with clear scoring and corrective recommendations.

Candidates should have 5+ years in WC claims adjusting or auditing, multi-state knowledge, and licensure where required.

Qualifications

• 5+ years of workers’ compensation claims adjusting and/or claims audit experience.

Responsibilities

• Audit workers’ compensation claims under delegated authority by TPAs.
• Evaluate quality, accuracy, compliance, and financial integrity of delegated claims handling.
• Apply standardized scoring criteria to file-level and program-level audits.
• Review medical management activities, assess reserve adequacy, and evaluate audit investigation quality.
• Document audit results in clear reports with scoring and corrective recommendations.

Skills

WC claims adjusting

Claims audit

Multi-jurisdictional WC

Statutory benefits

Reserving methodology

Medical management

Litigation practices

Adjuster licenses

MS Office

Claims systems

Audit tools

Tools

Claims systems

Audit tools

Job description

Responsibilities

• Conduct audits of workers’ compensation claims administered under delegated authority by third-party administrators (TPAs).
• Evaluate the quality, accuracy, compliance, and financial integrity of delegated claims handling.
• Perform file-level and program-level audits applying standardized scoring criteria.
• Review medical management activities, assess reserve adequacy, and evaluate audit investigation quality.
• Document audit results in clear written reports with scoring and corrective recommendations.

Requirements

• 5+ years of workers’ compensation claims adjusting and/or claims audit experience.
• Demonstrated multi-jurisdictional WC handling knowledge across multiple states.
• Strong understanding of statutory benefits, reserving methodology, medical management, and litigation/settlement practices.
• Adjuster license(s) as required by applicable jurisdictions (or ability to obtain).
• Proficiency with claims systems, audit tools, and Microsoft Office (Excel, Word).