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State of Washington Classified Job Specification

LABOR & INDUSTRIES AUDITOR 4

<< Classified Job Listing

LABOR & INDUSTRIES AUDITOR 4
152Q
Category: Financial Services

Definition

This is a senior level of this class series. Auditors at this level serve as a lead worker/or trainer.  

OR

Serves as a fraud auditor within a region, responsible for providing training and consultation to lower level auditors.

OR 

Works on specialized industry initiatives, such as the logger safety program, underground fraud, etc.  

OR 

Serves as a detection auditor in the Detection Unit, screening, analyzing, and identifying audit referrals.  

OR 

Serves in the Contract Release Unit, responsible for reviewing public works projects and verifying appropriate premiums are paid. 

OR 

Works in the Provider Fraud Unit as a provider fraud specialist auditing medical, vocational and other providers to identify patterns of wrongful billing. 

Typical Work

Acts as a lead auditor;

Performs audits, examines business’s financial records, contracts, systems accounting procedures and conducts appropriate interviews with management, staff and contractors to determine compliance with industrial insurance laws, rules, and regulations; analyzes contracts to determine job size and work type to convert dollars into labor; 

Independently and in conjunction with the investigation program, completes complex employer criminal audit cases. Performs extensive investigations including contact with claimants, local law enforcement agencies, competitors, and on-site visits, to identify fraudulent activities by an employer; investigates, documents, conducts interviews and prepares cases for criminal prosecution; 

During audits, assesses the physical environment of the business’s operations; conducts interviews and reviews records to determine the proper industrial insurance risk classification of employees;  

Apply relevant tools  to estimate premiums when employers fail to submit records, submit records that are incomplete, or when faced with cash payment and falsification of documentation; investigates and reviews waiver requests and tax rate recalculations, approves or denies in accordance with applicable laws, rules, regulations, policies and procedures; 

Uses independent judgment to challenge potentially fraudulent or incomplete records and extra-territorial issues involving other states, tribes, areas of federal jurisdiction, and international coverage; 

Conducts intensive investigations to bring the underground economy into compliance; conducts audits for the collection of unpaid premiums from the entities that contracted with the business;

Conduct audits on drywall industry;

Exercises subpoena authority to obtain records and may serve court-ordered subpoenas or assist the investigator with search warrants as necessary;

Identifies and develops work papers for assessment of prime contractor liability, which crosses business entities; conduct audits for the collection of unpaid premiums from the entities that contracted with the business;

Identifies situations where a business may be a successor or have a successor; performs successor audits on businesses of all sizes, scope and industry types and plans for an audit to carry the subsequent debt across to the other business(es); 

Audits and investigates businesses to make employer/employee relationship determinations on Workers’ Compensation claims; 

Identifies and refers other businesses for audit as a result of examining a’s business records.  Examples include entities with joint ownership and other businesses that an individual business contracts from or to;

Works in conjunction with investigators, Revenue Agents and others within the agency to develop a full picture of work activities and a comprehensive plan for audit and other compliance activities; 

Prepares a comprehensive audit report for review and approval by the unit supervisor.  This report and any resulting recommendation for assessment of premiums and penalties may be based on records or the lack thereof; reports and records from other parts of Labor and Industries, such as safety inspections, contractor compliance infractions, and the like; or information from third parties and other taxing agencies;

Discusses audit findings and the reasons behind them with employers and/or their representatives, such as a Certified Public Accountant or attorney.  Identifies issues, and works to develop appropriate solutions and educates the employer in proper recordkeeping and reporting procedures; 

Supports the audit through reconsideration and appeal processes, including preparing depositions, attending mediation conferences and testifying before the Board of Industrial Insurance Appeals or the courts; 

Independently, and in conjunction with the statewide trainer, develop and present training material to auditors and other staff that interact with classifications, compliance or fraud, and to external customers and stakeholders.  Lead in developing employer education modules specific to industries; delivers employer education presentations to individual employers or providers or in workshops; 

Reviews lower level staff work for accuracy and completeness to ensure compliance with applicable Laws, Rules, Regulations, Policies and Procedures; 

Monitors and evaluates unit/program operations to ensure compliance and acceptable level of performance to achieve agency set standards and goals;

Provide technical assistance and guidance to lower-level staff, or lead audit teams working on extremely large and complex audits, complex fraud audits or specialized focus efforts.  Oversee complex civil and criminal fraud audits, including direction of staff from other fields of expertise as required; 

Assists staff in investigating and resolving complex tax issues, to include audit findings, misrepresentation, fraud, petitions for appeal, tax evasion, employer liability determinations, correct tax rate assignments, or other legal issues.  Responds to inquiries by employers, employer representatives, and other state and federal agencies, in person, by telephone, or with written correspondence relating to these issues:

Fraud Unit:  Works on specialized industry projects. Completes complex industry audits on statewide projects. Conducts specialized industry research to develop complex formulas and checklists of financial records and items by region to use for verification of employers’ payroll records and reports to the department   Writes and maintains an industry manual at the direction of the central audit program to be used as a resource by other auditors; document common reporting discrepancies and specialized audit techniques for targeting non-compliance within the industry or provider group; 

Detection Unit:  Serves as specialist in the detection and screening of potential cases for audit of industrial insurance reporting compliance; screens and develops leads from internal and external referral sources, scores based on set criteria and knowledge, and refers for assignment as appropriate based on thresholds, unit staffing and backlog; researches matches from various data runs, scoring, developing and referring as appropriate; develops and assists in the design of new detection methods and tools, working in conjunction with other programs within the agency, and other taxing agencies and sources of information.

Contract Release Unit:  Reviews public works projects to determine if all industrial insurance premiums have been reported and paid and for compliance with prevailing wage and contractor registration requirements.  Analyzes certified payroll reports, intents, affidavits, and contracts to determine compliance with all reporting requirements.  Reviews risk classifications to determine if hours have been reported properly. Works with the awarding agency, prime contractor, and sub-contractors to ensure compliance and timely release of retained funds. 

Provider Fraud Unit:  Develops audit plans, sampling, on-site work and preparation of a comprehensive report.  Positions focus on medical billing laws, rules and regulations for industrial insurance.  All provider fraud positions are working on cases that are or may be developed for referral for criminal charges as well as civil misrepresentation (fraud); 

Performs other duties as required. 

Knowledge and Abilities

Knowledge of:  Washington Workers’ Compensation Insurance Manual, WAC 296-17; Title 51 RCW; legal precedents; rules, policies and procedures of the Department of Labor and Industries; auditing and accounting theory and practices; analytical procedures; industry practices; computerized accounting systems, modern business methods, procedures and equipment, and education and workshop techniques.  

Ability to:  analyze problems and find creative solutions; organize and use time effectively; inspire trust and cooperation; develop teamwork in a group of auditors; work compatibly with taxpayer staff; prepare comprehensive and accurate audit reports; analyze income statements and numerical relationships; communicate effectively, both orally and in writing, and conduct employer or provider education (individually and in workshops).

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position. 

Desirable Qualifications

A Bachelor’s degree that includes at least 20 semester or 30 quarter hours in accounting (may include credits from one (1) Finance class or one (1) Business Law class  

AND 

Three (3) years of professional accounting or auditing experience.

OR 

Successful completion of the Labor and Industries Auditor Training Program.

OR

Equivalent education/experience will be considered but must include at least 20 semester or 30 quarter hours in accounting (may include credits from one (1) Finance class or one (1) Business Law class).  

Class Specification History

New class, effective September 15, 1995.
Revised definition, effective May 9, 2001.
New class code, formerly 13785; effective July 1, 2007.
Revised definition; adopted November 12, 2015, effective November 13, 2015.
Revised typical work, knowledge and abilities, and desirable qualifications; updated November 12, 2015.
Salary adjustment adopted 6/30/2015, effective 7/1/2015.

 

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