Supervisor Audit & Compliance

Claims Audit Supervisor

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We are proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here!

Purpose Of The Job

The purpose of this job is to supervise functions of claims internal controls and to monitor team activities with a focus on trends and quality compliance. This position is responsible for the development and execution of the Claims audit program, identifying trends and promoting continuous improvement. This role exists to ensure that Claims Administrations is adhering to regulatory and internal guidelines as they apply to claims processing and adjudication. This position will collaborate with other teams to develop strategies to identify, mitigate and optimize operational and financial gaps.

Essential Duties And Responsibilities

Develops and provides oversight of the Claims Audit & Compliance program.

• Develops and executes end-to-end claims audits.
• Ensures the Audit plan covers all aspects of claims adjudication.
• Analyzes jurisdictional requirements for changes and proposes changes to the audit plan.
• Proactively identifies focus areas for audits based on trends / data and inputs from external audits and makes required adjustments.
• Ensures clear metrics are defined, measured, and reported for tracking and trending claims audit outcomes.
• Analyzes audit results, identifies trends, and makes recommendations for areas of improvement.
• Prepares and delivers audit results to the management team.
• Works with other teams to develop and orchestrate applicable corrective action plans with a feedback loop to other claims teams to ensure deficiencies do not reoccur.
• Collaborates with leadership to ensure service and quality levels are within standard operating procedures for the department.
• Ensures financial and procedural claims audits are performed in a timely manner based on various sampling methods.
• Provides overall monitoring of production volume, quality, and turnaround time; establishes appropriate and effective production goals and quality benchmarks for the team.
• Ensures adherence to the daily and scheduled focused audit plan.
• Conducts regular, ongoing review and analysis of all Claims Auditors to ensure audit quality and accuracy.
• Ensures continuous calibration and consistent understanding and adherence to claims best practices.
• Analyzes quality issues and provides feedback to the auditors.
• Reviews audit schedule for the department and adjusts as needed.
• Develops questionnaires and manages assessments for internal audit tool.
• Utilizes tools and technologies effectively to develop, maintain, update, or revise all audit tools, scorecards, dashboards, and reporting templates, as necessary.
• Oversees the preparation of audit responses to all internal and external audits.
• Develops and implements training programs and workflows for Audit & Compliance program.
• Works closely with training specialist and claims management staff to correct deficiencies and address technical training needs.
• Maintains technical workers compensation expertise on assigned jurisdictions.
• Coordinates training schedules and evaluates applicable outside training resources.
• Collaborates with department leadership to develop tools to ensure compliance.
• Develops and supervises a team of Audit & Compliance professionals.
• Provides daily direction to Audit & Compliance team.
• Communicates Mission, Values, and other organization operating principles to direct and indirect reports.
• Establishes and maintains the overall work cadence and, in partnership with department leadership, ensures performance and outcomes strive for excellence in delivery and customer experience.
• Ensures that the entire team is engaged and that leadership practices encourage development, recognition, and retention.
• Adheres to hiring criteria, on-boarding, and training requirements for incoming staff.
• Oversees the performance management and development process for the team and performs performance management duties, development planning, and coaching for direct reports.
• Acts as a resource for team members to answer questions and solve complex problems.
• Manages budget, technology and other resources, workload, and customer requests for Department services.
• Ensures adherence to all Company policies and procedures and Compliance responsibilities.
• Ensures data quality, adherence to IT security guidelines, profitability and other risk-related metrics for self and members of the team.

Supervisory Responsibilities

Directly supervises employees within the Audit & Compliance team and carries out supervisory responsibilities in accordance with company policies and applicable laws. These responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; conducting performance and salary reviews; rewarding and disciplining employees; addressing complaints and resolving problems; coaching, mentoring, and developing team members to further their skills and knowledge; creating and monitoring development plans; setting performance expectations / goals; forecasting staffing needs and planning for peak times and absences; enforcing department policies and procedures.

Education And Experience

Bachelor's degree preferred with a major or emphasis in Business, Management, or related field. Minimum 6 years of claims audit experience or related experience required. Supervisory experience preferred. Multi-line experience preferred.

Certificates, Licenses, Registrations

None required.

Knowledge And Skills

Strong knowledge of Workers' Compensation insurance principles and practices. Knowledge of requirements for NCCI, WCIRB, and other specific State reports such as WCIS or DWC's. Excellent written and verbal communication skills required, as well as time-management, good organizational skills, sense of urgency, and attention to detail. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Knowledge of personnel and performance strategies. Ability to effectively present information to management and / or public groups. Ability to define problems, collect data, establish facts, and draw valid conclusions.

Physical Requirements

Office environment no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.

Work Environment

This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment.

Why Join ICW Group?

Challenging work and the ability to make a difference. You will have a voice and feel a sense of belonging. We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match. Bonus potential for all positions. Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year). 11 paid holidays throughout the calendar year. Want to continue learning? We'll support you 100%. ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex / gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.

At ICW Group we offer a work environment that encourages entrepreneurialism and celebrates success. Our team members are hands-on contributors who are given the opportunity to make an impact. It's our people who make us an employer of choice and the vibrant company we are today.