A class incumbent investigates randomly selected claims to identify benefit errors and their causes so that corrective action can be taken.
Nature and Scope
A class incumbent performs with general supervision from the Unemployment Insurance Quality Control Supervisor and is responsible for validating unemployment benefits' eligibility criteria and the payment of benefits. This work involves performing a thorough investigation of randomly selected claims: auditing employer payroll records; interviewing claimants, schools, medical personnel, agencies and public officials to verify or obtain additional information; reviewing agency records; recalculating benefits; determining fraud or misinterpretation. The incumbent plans own schedule and conducts on site audits as far as 50 miles away. All findings are reviewed by the unit supervisor or data analyst; a percentage of the findings are also reviewed by federal regional office and the national office. The Quality Control Unit reviews a random sample of claims filed each year; however, the results are generalized to the entire population of unemployment claims.
Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
Review agency records to determine compliance with applicable regulations.
Perform audits of manual and computer payroll records to verify reported claimant quarterly wages, earnings, deferred compensation, taxable benefits and payroll deductions.
Confer with employers or their representatives to discuss findings and respond to questions.
Prepare written report on employer audit reviews and findings and responds to employer questions.
Complete wage verification forms to determine if benefit payments were properly paid; compute over and underpayments and determine fraud or misinterpretation of unemployment regulations.
Conduct sensitive, confidential interviews with claimants, educational institution staff, doctors, hospitals, public officials, various agencies to determine eligibility or disqualification issues and to verify job search activities.
Complete all case review documents and prepares narrative statement of findings, citing legal bases for proper determination.
Code case data; enter data into computer.
Utilize system data bases to access necessary information to review cases.
Attend appeal hearings on audited cases to testify as a witness.
Knowledge, Skills and Abilities
The intent of the listed knowledge, skills and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.
Knowledge of unemployment laws, rules, regulations and guidelines, specifically claims eligibility determinations.
Knowledge of division regulations, guidelines, procedures.
Knowledge of auditing practices, procedures and methods.
Knowledge of accounting systems used by proprietorships, partnerships, and corporations.
Skill in interviewing and investigation.
Skill in analyzing data and making sound judgments/ recommendations.
Skill in planning and organization.
Skill in tact, diplomacy and persuasiveness.
Skill in preparing clear and concise reports.
Skill in effective oral and written communication.
Ability to utilize computer databases and code date.
Ability to establish effective working relationships.
JOB REQUIREMENTS for Unemployment Insurance Quality Control Auditor
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
Six months experience in accounting using Generally Accepted Accounting Principles (GAAP).
Six months experience in auditing financial records and documents in accordance with Generally Accepted Auditing standards, including assessment of internal and external controls.
Six months experience in computer assisted auditing which includes using computer programs to analyze data, select, manipulate and sort data, perform calculations, select audit samples and print reports.
Six months experience in conducting investigations which includes conducting interviews to obtain confidential information, gathering evidence and documenting findings.
Six months experience in interpreting laws, rules, regulations, standards, policies, and procedures.
Six months experience in narrative report writing.