Work at MEMIC
Location: Portland, ME
The Claim Auditor is responsible for analysis of claim staff work product to ensure compliance with MEMIC Claim Department best practices, policies, and procedures. The Claim Auditor will conduct periodic retrospective file audits in accordance with MEMIC’s claim audit plan. They will also review select claim files on a real-time basis to ensure accuracy with regard to compensability decisions, form filing, benefit payment, and file documentation. While carrying out these duties, the Claim Auditor will complete audit forms and summary reports to be shared with members of the claim management team.
- Completes claim file audits and reviews on both a retrospective and real-time basis in accordance with the MEMIC Claim Department audit plan.
- Items to be reviewed include claim compensability decisions, payments, form filing, file documentation, and resolution strategies.
- Provides written documentation explaining whether individual claim staff work product meets MEMIC Claim Department best practices, policies, and procedures.
- Reviews and audits work product of third party claim administrators at regularly scheduled intervals.
- Assists with the development and updating of audit forms, audit procedures, electronic data interchange processes, and jurisdictional specific procedure guides.
- Assists Claim Department management team members with the coordination and reconciliation of external claim audits and data requests.
- Assists the department with training, mentoring, and development of claims team.
- Acts as a resource for the claims compliance unit on an as-needed basis.
- Requires a Bachelor’s degree with a minimum of 3-5 years’ experience handling complex workers’ compensation claims or an equivalent combination of education and experience.
- Must possess a sound working knowledge of MEMIC claim procedures, best practices, and auditing standards.
- Must have an excellent understanding of the scope and application workers’ compensation laws for all states where MEMIC provides coverage.
- Must have excellent written and verbal communication skills.
- Must be organized and able to multi-task while working with stakeholders across the MEMIC Claim Department.
How to Apply:
Apply by sending resume to email@example.com. You can call us at 1-800-660-1306.