Text Size:   A+ A- A   •   Text Only

    Barbara Belcher   
503-947-7687   

Audit Unit

 

Contact Us

Do you have a specific question for audit unit? Send an email to Ask an auditor

 

Purpose

To ensure insurer and self-insured employers' compliance with claims processing requirements, validate expenditures from the Workers' Benefit Fund, and oversee Oregon's certified managed care organizations.

 

Responsibilities

Insurer compliance with claim processing requirements: The team conducts performance audits of insurers and self-insured employers to ensure compliance with claim processing rules and statutes, and to gather data on industry performance and provide mandatory industry training in low-performing claim processing areas.

Expenditures from the Workers' Benefit Fund: Auditors validate from insurer and self-insured employer records that expenditures meet eligibility requirements and require monetary adjustments as necessary.

Managed Care Organizations: The team certifies managed care organizations, monitors and investigates managed care activities in the workers' compensation system.
 

Functions

Auditors develop and conduct various audits, including the annual audit of claims processing and benefit payment timeliness, focused audits on specific claims processing performance areas, and audits of expenditures from the Workers' Benefit Fund.

Audits may be performed on the following programs funded by the Workers' Benefit Fund: Workers with Disabilities Program, Reopened Claims Program, Preferred Worker Program (claim costs), Employer-at-Injury Program, Noncomplying Employer Program, and Supplemental Disability Benefits.

Auditors certify managed care organizations and monitor their performance and related managed care activities by insurers and self-insured employers. The team also investigates complaints and allegations of inappropriate direction or management of medical care by employers, insurers, or other parties.
 

Primary governing rules

All WCD administrative rules govern the work of the Audit Unit.
 
 
For more information contact:
Audit Unit: 503-947-7687
FAX: 503-947-7725

If you have questions about this webpage, please contact Barbara Belcher, 503-947-7687.