Claims Auditor

This is a standard position description for use in the Workers' Compensation program in which the claimants' files are reviewed and audited.

Under the general supervision of a higher-level officer, an employee in this class audits all vouchers for payment, files for medical recovery payments, and all expenditures of monies relative to the payment of Workers' Compensation.

• Audits all orders and vouchers for payment to claimants, medical providers and institutions.
• Records checks when they arrive from the Department of Finance.
• Verifies that the amount is correct and is made payable to the correct claimant or provider.
• Audits files to ascertain that they do not go over the medically established on-island or off-island ceiling for medical treatment.
• Provides lien to attorneys for third party settlements.
• Verifies the calculation of third party settlements owned to Workers' Compensation.
• Prepares various statistical and monthly reports of money expended by the Government Insurance Fund, total cases of injuries received, total questionable, numbers denied, and unusual cases received, along with other figures relative to the program.

Bachelors of Arts Degree including six (6) credits in accounting. 
Associates of Arts Degree or its equivalent in credits, including six (6) credits in Accounting, and two (2) years experience in work dealing with Labor Relations or Workers' Compensation.FACTOR 1 - KNOWLEDGE REQUIRED BY THE POSITION

• Knowledge of basic accounting.
• Knowledge of basic medical terms and terminology.
• Knowledge of the appropriate provision of the Virgin Islands Workers' Compensation Act.
• Knowledge of the concepts, rules, regulations policies, and procedures of Virgin Islands Division of Workers' Compensation and their application to specific situation.
• Ability to calculate payments of claims accurately.
• Ability to assist in analyzing reports and claims.
• Skill in the operation of a computer/word processor necessary for preparing statistical reports.
• Computer literate.

 FACTOR 2 - SUPERVISORY CONTROLS
Work is performed under the general supervision of a higher level officer. Work is assigned on a daily basis. All work related to expenditures of monies is assigned to auditor. The employee is responsible to make sure figures are correct.
 
FACTOR 3 - GUIDELINES
Guidelines consist of agency manuals on instructions and operations, local and national labor laws, and guidelines, codes and rules and regulations as they relate to Workers' Compensation.
 
FACTOR 4 - COMPLEXITY
The employee in this position is performs basic auditing work. It requires verifying data gathered in the claimant's file and justifying why a specific amount has been disbursed for the specific case.
 
FACTOR 5 - SCOPE AND EFFECT
The purpose of this position is to gather data, and perform audit pertaining to the distribution of funds relative to claims for file for Workers' Compensation.
 
FACTOR 6 - PERSONAL CONTACTS
Contacts are made with the general public, other government agencies, contractors, medical providers, employers, co-workers, and attorneys.
 
FACTOR 7 - PURPOSE OF CONTACTS 
Contacts are made to obtain, verify transmit or exchange information as they relate to employees and employers.
 
FACTOR 8 - PHYSICAL DEMANDS
Work is mostly sedimentary: however, some walking and driving may be required.

FACTOR 9 - WORK ENVIRONMENT
Work is mostly performed in an office setting.