Senior Premium Audit Operations Specialist

The Senior Premium Audit Operations Specialist manages complex audit reviews, escalated adjustments, and advanced regulatory compliance across multiple states and jurisdictions. This role leads classification reviews, oversees intricate billing and endorsement scenarios, and serves as an expert on special bureau requirements. The specialist handles challenging customer engagements, resolves disputes, and develops best practices for communication and service excellence. Additional responsibilities include mentoring and training team members, supporting process improvements, and contributing to strategic planning and policy development. The position requires strong analytical skills, effective multitasking, and a commitment to confidentiality and high performance standards.

Advanced Audit Operations & Processing:

• Review and process complex audit worksheets from all audit types with expanded authority limits.
• Handle escalated audit adjustments and complex regulatory compliance scenarios.
• Provide expertise on special bureau requirements (PA/DE, CA, NJ, NY) and unusual jurisdictions.
• Lead classification reviews for complex business operations and unusual industry scenarios.
• Ensure compliance with advanced regulatory requirements across multiple states.
• Process complex endorsements and handle intricate billing scenarios.

Strategic Customer Communication & Relationship Management:

• Lead complex customer engagement scenarios involving significant additional premiums.
• Handle escalated dispute resolution cases and difficult customer conversations.
• Develop and refine customer communication scripts and best practices.
• Mentor P3-level staff on effective customer engagement techniques.
• Build and maintain relationships with challenging accounts and high-value customers.
• Serve as subject matter expert for customer service excellence initiatives.

Advanced Billing Integration & Process Leadership:

• Oversee complex billing handoff scenarios and coordinate with multiple departments.
• Analyze sophisticated payment structures and develop customized solutions.
• Support Team Lead in implementation of new billing integration processes.
• Provide expertise on payment plan structures and collection strategies.
• Document and refine complex handoff procedures for team training.

Training & Mentorship Responsibilities:

• Mentor P3-level Premium Audit Operations Specialists and other team members.
• Develop training materials and conduct training sessions on advanced procedures.
• Provide guidance on complex audit scenarios and regulatory requirements.
• Lead knowledge sharing sessions and best practice development.
• Support onboarding of new team members.

Process Development & Strategic Planning:

• Lead process improvement initiatives and strategic planning sessions.
• Provide advanced feedback on department transformation strategies.
• Contribute to policy development and procedure refinement.
• Analyze performance metrics and recommend operational enhancements.
• Support implementation of emerging technologies and process innovations.

Quality & Performance Standards:

• Meet established deadlines and manage multiple priorities effectively.
• Maintain strict confidentiality of all processed information.

• Minimum 5-7 years as a Workers Compensation premium auditor or premium audit reviewer.
• Advanced knowledge of NCCI, WCIRB, PCRB/DCRB rules and regulations.
• Substantial experience with special bureaus: PA/DE, CA, NJ, NY required.
• Multi-state audit expertise and complex regulatory knowledge.
• Leadership or mentoring experience in the insurance operations environment.

Advanced Technical Competencies:

• Expert understanding of premium audit procedures and regulatory compliance across all states.
• Advanced proficiency with classification systems and specialized bureau requirements.
• Experience with complex audit software systems and emerging technologies.
• Advanced billing and payment processing knowledge.
• Ability to analyze complex accounting structures and sophisticated business operations.

Leadership & Communication Excellence:

• • Exceptional verbal communication skills for complex customer interactions.
  • Advanced written communication abilities for high-level correspondence.
  • Proven ability to explain intricate financial and regulatory concepts clearly.
  • Experience managing difficult customer relationships and complex disputes.
  • Training and mentoring capabilities.
  • Cross-functional collaboration and influence skills.

The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. All AI-reviewed applications are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process.