Issue 157 - March 2025
NEWS: WORTHY
2025 Workers’ Compensation Claims Audit
The California JPIA conducts an annual independent audit of our workers’ compensation third-party administrator (TPA), Athens Administrators. Jim Bankson has performed these audits since 2017, and his process focuses on the TPA’s compliance with the Authority’s key performance indicators.
Bankson has more than 45 years of experience in insurance, including owning his own TPA. He has also consulted several organizations and is well-suited to assess our TPA’s performance and identify areas for improvement. His audit begins with an online review of 150 randomly selected open claims, including a sample from each of our assigned claims examiners. The audit emphasizes key performance indicators established by the Authority, compliance with statutory requirements, and industry best practices. Following his initial audit of the individual claim files, Bankson engages in dialogue with TPA staff to confirm that his assessment of each claim is correct. Once this dialogue is complete, he calculates the TPA’s final score.
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This year’s score of 94.28 percent represents a more than two percent increase over last year’s 92.17 percent mark. This score also marks the claims team’s 15th consecutive audit score of 90 percent or higher.
“The collaborative approach Athens takes to managing claims, paired with consistent examiner staffing, is a key part of their success with the Authority,” said Jeff Rush, workers’ compensation program manager.
If members have any questions or feedback regarding the workers’ compensation programs or the recent audit results, they are welcome to contact Jeff Rush.
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