Insurance Claims Auditor Jobs (NOW HIRING)

Salary: $42,553.00 Annually
Location : St. Thomas/ St. John, VI
Job Type: Classified
Job Number: 201905468
Department: |Department of Labor- STT|
Opening Date: 08/24/2026
Closing Date: 9/4/2026 11:59 PM Atlantic (Canada)
Description
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.
Duties and Responsibilities
DUTIES (NOT ALL INCLUSIVE)

• 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.

Minimum Qualifications
Bachelors of Arts Degree including six (6) credits in accounting.
OR
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.
Position Factors
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.
The Government of the Virgin Islands aspires to provide the highest level of comprehensive benefits, services and programs to eligible employees, retirees, and their dependents which:

• Meet and anticipate their individual needs;
• Assure the GVI's competitiveness with other employers to attract and retain employees;
• Maximize cost effectiveness; and,
• Assure optimal health and productivity of employees.

To achieve this goal, from time to time, the carrier for the GVI's insurance may change. Please contact the Group Health Insurance Office of the Division of Personnel in St. Thomas and St. Croix at for more information regarding carriers.
Medical and Dental Coverage
Enrollment
The Virgin Islands government offers to full-time employees and their eligible dependents, a group health and dental insurance plan.
Full-time employees must enroll within thirty-one (31) days of hire unless they can provide proof of medical coverage from another source. An employee who does not enroll within 31 days of employment will be automatically enrolled in the health insurance plan with single coverage.
If an employee fails to enroll dependents within the initial eligibility period he/she must wait until a period of "open enrollment" is announced or have a qualifying event as determined by the health insurance carrier to enroll dependents or make changes to their coverage.
Effective Date of Coverage
If enrollment forms are received on or before the 6th of the month, coverage will be effective on the first day of the first month following the receipt of enrollment forms. If enrollment forms received on the 7th of the month or later, coverage will be effective on the first day of the second month following the receipt of the enrollment forms.
Example:
Date Forms Received May 1st May 8th January 6th February 7th
Coverage Effective Date June 1st July 1st February 1st April 1st
Dependent Coverage
Dependents of eligible employees may participate in the Group Health and Dental Insurance Program according to the terms and conditions imposed by the Health Insurance Board of Trustees and/or the carrier. Eligible dependents are the employee's:

1. Legal spouse;
2. Natural children;
3. Adopted children; and
4. Step children.

When a new dependent is acquired, you must enroll them within thirty-one (31) days after acquiring such dependent. When enrolling a dependent at any time, the following may be required:

1. Birth certificate;
2. Marriage certificate;
3. Adoption papers; and/or
4. Legal papers of appointment.

Various other documents may be required to determine the eligibility of the dependents.
Cost of Coverage
The GVI contributes toward the cost of Health Insurance for each employee enrolled under the Group Health Insurance Program. The GVI reserves the right to change the amount of the employee contribution when necessary for financial or other reasons.
Waiver or Discontinuation of Benefits
An employee may opt to decline coverage, or discontinue coverage under the Group Health and Dental Insurance Plan at any time. An employee who waives coverage upon employment, or who drops out of the program must provide proof of medical coverage and will be subject to the eligibility requirements imposed by the carrier in order to re-enroll in the program. This provision also applies to dependents that are dropped from the plan.
Coverage discontinues on the last day of the month following a qualifying event or on the date of an employee's separation.
After separation, an employee or dependent may be eligible to convert their group policy to an individual policy within 30 days, depending on the insurance carrier. If an employee would like to convert their policy to an individual policy a notice of conversion must be sent to the insurance carrier. Consolidated Omnibus Budget Reconciliation (COBRA) coverage is not available in the Virgin Islands after loss of coverage.
Dental Insurance
As a condition of participation, all employees must enroll in medical coverage to qualify for Dental Insurance.
Leave without Pay
The GVI will maintain group health insurance plan coverage for employees on leave without pay. This coverage will remain at the level and under the conditions for which coverage would have been provided if the employee had continued employment continuously for the duration of the leave. However, employees on leave must arrange to pay into the Group Health Insurance Fund the employee's share of their health insurance premium to maintain coverage.
Retirement Benefits
Retired employees and their dependents are eligible to continue to participate in the Group Health and Dental Insurance Program. Retirees must provide updated contact information to the Group Health Insurance Division to maintain coverage.
Life Insurance
The government provides a complementary basic non-contributory $10,000 basic life insurance benefit. In order for the benefit to be effective, an enrollment form must be forwarded to the Group Insurance Office at the Division. The enrollment form must be signed, dated and must indicate a designated beneficiary.
Employees may also select additional life insurance in either 1x, 2x, 3x or 4x base salary or $10,000, $15,000, $25,000, $50,000, $75,000, $100,000 or $150,000 amounts as supplemental contributory coverage. The employee pays the cost of this additional insurance, and may be required to submit evidence of insurability when increasing coverage after initial enrollment. Insurance enrollment forms and booklets explaining in detail the plan of benefits, as well as claim forms and a schedule of costs may be obtained from the Group Health Insurance Office.
Upon retirement life insurance benefits may be reduced.
Upon death the designated beneficiary will be eligible to receive the life insurance proceeds of the insurance participant, the Division must be notified of the death in order to initiate the claim process. Life insurance benefits are payable by the contracted insurance company and a subject to the limitations established by the insurance company.
Supplemental Insurance
The GVI has several supplemental insurance plans that provide for coverage over and above the regular medical, dental and life insurance coverage.
These plans are voluntary and are not contributed to by the GVI. A list of the current supplemental insurance plans is available through the Group Health Insurance Office. An employee who does not wish to enroll in medical coverage is eligible to enroll in supplemental insurance.
Moving and Relocation Allowance
It is the policy of the GVI to provide a reasonable relocation allowance inclusive of airfare, to eligible employees, based on their employment contract, to help defray the costs associated with relocation from outside the Virgin Islands to accept employment with the GVI. This allowance is made in lieu of any and all claims for reimbursement of relocation and moving expenses.
This policy applies to new employees recruited from off-island and who are approved by the Department Head to receive the benefit of a relocation allowance for moving and relocation expenses.
Employee Assistance Program (EAP)
The GVI will provide confidential and voluntary assistance through its Employee Assistance Program (EAP) to all employees and their family members who may be faced with dynamic challenges of financial concerns, legal issues, alcohol or drug problems, marital problems, illness of a family member, emotional worries, child care problems, etc. For the welfare of employees as well as effective business operations, the GVI encourages its employees to take advantage of this valuable benefit of employment with GVI.
Application
Employees and their family members can refer themselves to the EAP. The program may be reached 24 hours a day on weekdays and weekends.
EAP counselors are available to meet with employees or family members to assess a problem and develop a plan for resolution. The counselors may suggest a referral to an outside resource, such as a therapist, Departmental resource, physician, treatment facility or other professional that would be appropriate to assist in resolving the problem or situation. Where an employee may be in need of information, a referral or suggestion may be made over the telephone. There is no charge for employees or their families to use the services of the EAP.
Participation in the EAP Program does not jeopardize job security or promotional opportunities. However, it does not excuse the employee from following GVI policies and procedures or meeting required standards for satisfactory job performance except where specific accommodations are required by law.
Time Away from Work
Employees who want to visit the EAP during regular work hours must use sick, vacation or personal time after their first meeting. If illness is involved, compensatory, sick, and/or annual leave may be used for treatment or rehabilitation on the same basis that it is granted for other health problems.
Mandatory EAP meetings will be completed using administrative leave.
The EAP counselors will make every effort to coordinate referral for ongoing treatment with the employee's health insurance coverage as well as his/her ability to pay.
Mandatory EAP
When an employee's job performance or attendance is unsatisfactory or there appears to be signs of other problems during the work day, the supervisor should counsel the employee in consultation with the human resources officer or designee. If the employee appears to be unable or unwilling to correct the situation, the employee may be referred to the EAP to assist in the resolution of the problem. Depending on the situation, the employee may accept or refuse participation in the EAP. However, there may be situations where continued employment with the GVI may be contingent upon the employee calling the EAP for assistance.
REMINDER: All contact between an employee