Newsletter

2024 Workers’ Compensation Claims Audit

The California JPIA conducts an annual independent audit of our workers’ compensation third-party administrator (TPA). Jim Bankson has performed these audits since 2017, and his process focuses on the TPA’s compliance with the Authority’s key performance indicators.

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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 claims, including a sample from each of our assigned claims examiners.  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.

This year’s audit marks the first for the Authority’s new TPA, Athens Administrators.  Entering this audit, our claims team had surpassed the 90 percent threshold for 13 consecutive years. We are happy to share that even with the challenge associated with the transition to a new TPA, this streak remains intact, with a score of 92.17 percent. If members have any questions or feedback regarding the workers’ compensation programs or the recent audit results, they are welcome to contact Workers’ Compensation Program Manager Jeff Rush.

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