Compliance/Audit Investigators perform investigative and auditing functions to monitor compliance and detect violations of State and/or federal laws or regulations pertaining to a specific program or regulatory area such as securities, Medicaid, mortgage lending, or workers' compensation. Investigators allocated to this series do not require P.O.S.T. certification.
Incumbents possess a degree of knowledge and proficiency sufficient to perform advanced-level work and may provide work direction and training to others.
The Department of Business & Industry, Division of Industrial Relations, Workers' Compensation Section is recruiting for a Compliance/Audit Investigator 3 position located in Las Vegas, Nevada. The position is assigned to the Uninsured Employer Claims Account (UECA). The uninsured claims coordinator spends the preponderance of time coordinating workers' compensation claims assigned to the UECA; monitors all claims sent to the Third-Party Administrator (TPA) contracted with the State; coordinates all funding requests related to these claims and oversees the management of claims by the TPA to ensure that injured employees receive accurate and timely delivery of all workers' compensation benefits to which they are entitled to.
Additional job duties include: review claims that have been recommended for assignment to the UECA by the employer enforcement unit; review final audit reports and complaints for accuracy, clarity, format and ensure that policy and procedures were followed; and review final audit reports for the Subsequent Injury Fund. In addition, the position reviews requests for modifications to State mandated forms from Employers, TPAs, Insurers & Providers. This position requires a working knowledge of workers' compensation claims handling. Must have experience working with and applying NRS/NAC 616 A through D and NRS 617, which applies to the Nevada workers' compensation system.
To see full Class Specifications visit: http://hr.nv.gov/Resources/ClassSpecs/Class_Specifications-11_0/
In order to be qualified, you must meet the following requirements:
Education and Experience (Minimum Qualifications) Bachelor's degree from an accredited college or university in business or public administration, business management, accounting, or related field and three years of professional experience in an investigative, auditing or program-related position which required the application of state and/or federal laws, policy and procedure in making program compliance determinations; preparing detailed reports for the purpose of justifying administrative sanctions or penalties or changes in management practices, policy and procedure; or recommending criminal prosecution; OR graduation from high school or equivalent education and five years of experience, three of which were in a professional investigative, auditing or professional program-related position which required the application of state and/or federal laws, policy and procedure in making program compliance determinations; preparing detailed reports for the purpose of justifying administrative sanctions or penalties or changes in management practices, policy and procedure; or recommending criminal prosecution; OR an equivalent combination of education and experience; OR one year of experience as a Compliance/Audit Investigator II in Nevada State service. Special Requirements A valid driver's license is required at the time of appointment and as a condition of continuing employment. Additional Position Criteria Experience working with Nevada workers' compensation claims.
State Of Nevada