07/22/1995 70393

STATE WORKERS' INSURANCE FUND AUDITING TECHNICIAN

DEFINITION: This is technical work in the review of payroll records in order to recommend premium and policy modifications for policyholders covered under the State Workers' Insurance Fund.

An employee in this class reviews claims data and employer payroll records to evaluate the appropriateness of the policy's employee work classifications and experience modification factors. Audits are performed to ensure consistency with prior classifications and factors, and may result in recommended modifications which change policy premiums. Work may include on-site audits of payroll records to resolve inconsistencies. Work also includes the review and evaluation of payroll classification audits conducted by contracted auditors. Work is performed within the framework of the rules and regulations issued by the Pennsylvania Compensation Rating Bureau, the Coal Mine Rating Bureau, the Pennsylvania Workers' Compensation Law, and S.W.I.F. operating procedures. Work is reviewed by a S.W.I.F. Auditing Supervisor for quality and timeliness of audit processing.

EXAMPLES OF WORK: Reviews and reconciles audited policy information received from contracted auditors and through mail canvass with policy and claims information on the S.W.I.F. automated system: evaluates appropriateness of employer payroll and employee work classification information, applicability of experience modification, and designation of subcontractors in order to determine accurate coverage and recommend revisions which may change premiums for workers' compensation and employers liability insurance policies issued by the State Workers' Insurance Fund.

Reviews documents to determine employer/employee relationship.

Recommends that contracted auditors conduct follow-up on-site reviews when information is incomplete or appears to have discrepancies based upon existing data.

Goes on-site to policyholder location to obtain additional information concerning payroll allocation when this cannot be accomplished, through the review of documents provided.

Determines correct premium amount for the prior year based upon the actual payroll figures for the year.

Prepares memos to recommend modifications to a policy, including entity changes, class changes, additions, deletions, or other pertinent information.

Enters corrected data into S.W.I.F. Computer System.

Responds to inquiries from insurers, brokers, attorneys and other interested parties concerning audit findings or policy changes.

Reviews information to determine corporate officers' payroll allocation.

Performs related duties as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of the principles and practices of casualty insurance auditing.

Knowledge of the basic provisions of casualty insurance policies and related forms.

Ability to interpret and comprehend basic casualty insurance related terms and data.

Ability to learn to apply the provisions of Pennsylvania Workers' Compensation Law, the rules and regulations of the Pennsylvania Compensation and Coal Mine Rating Bureaus, and State Workers' Insurance Fund procedures and guidelines pertaining to the assessment of experience modification factors, claims data, and employer payroll work classification allocations depicted in policies for Workers' Compensation Insurance coverage with the State Workers' Insurance Fund.

Ability to ascertain facts needed and secure information through oral and written communication and on-site audits of employer payroll records.

Ability to learn to use the specialized automated office procedures, practices and equipment used to access information and to initiate policy changes.

Ability to organize and evaluate facts and draw sound conclusions.

Ability to establish and maintain effective working relationships with employers, insurance brokers, office staff, and the general public.

Ability to express ideas effectively, orally and in writing.

MINIMUM EXPERIENCE AND TRAINING: Two years in casualty insurance auditing and/or underwriting experience which included the assignment of classifications and application of proper rates, premium computations, policy assessment, and the issuance of new or revised policies;

or

Any equivalent combination of experience and training.