EDI Compliance Analyst

| 100% Remote (WFH) Opportunity

General Summary

Under the direct supervision of the Corporate Claims Manager and EDI Supervisor, the EDI Compliance Analyst monitors, coordinates and administers various electronic regulatory reporting processes for the Claims Department. The EDI Compliance Analyst ensures that the regulatory reporting of Claims data, whether electronic or on paper, occurs accurately and within appropriate timeframes in compliance with established internal, State and Federal rules.

Essential Duties And Responsibilities

• Submits, monitors, and validates electronic transactions for Claims regulatory reporting processes including, but not limited to:
• CMS Section 111 Reporting
• IAIABC First and Subsequent Reports of Injury (FROI/SROI) for all state jurisdictions
• IAIABC Medical Bill EDI Reporting
• ISO Child Support Enforcement Agency (CSEA) Program / Child Support Lien Network (CSLN)
• NCCI Detailed Claim Information (DCI) Reporting
• NV DIR Claim Index Reporting
• WCIRB, NCCI, DE, PA, MA, NJ, NY, and WI Medical Data Call Reporting
• WCIRB, NCCI, and NY Indemnity Data Call Reporting
• UNIT STAT
• Handles the error rejection process to ensure complete report submission occurs
• When required, assists with the handling of additional electronic and paper data calls received from State and Federal agencies.
• Communicates effectively, professionally, and courteously, in writing and verbally, with all internal and external customers.
• Provides training to claims staff regarding required claims system data fields to meet state reporting requirements.
• Responds timely to external third party reporting vendors and regulatory agencies to resolve reporting issues when needed.
• Conducts annual research of both new and existing bureau mandates for EDI reporting requirements to determine if electronic interface updates and/or new report development is required.
• Interprets state and federal reporting mandates for the IT Business Analyst and/or Data Analytics report developer to implement new reporting processes.
• Assists with testing of new regulatory reports to validate code development is accurate.
• Assists with regression testing of existing interface reports when Claims System upgrades or new releases are implemented.
• Notifies management of pending issues, production concerns, or when potential changes to reporting procedures or regulations are identified.
• Researches the nature of problems, identifies potential solutions, and executes resolution independently when appropriate.
• Meets quality, accuracy and productivity objectives and goals for error correction with minimal assistance and/or guidance and prevents reporting penalties.
• Other duties as assigned.
  
  

Requirements

• Minimum 5 years experience in the Workers’ Compensation or P&C industry working with claims data, experience in electronic regulatory reporting preferred, or 3 years in a related field.
• A working knowledge of insurance principles as related to the applicable state-specific reporting rules, federal reporting rules, IAIABC reporting standards, internal system triggers, and reporting timeframes to ensure compliance and penalty avoidance.
• Must have excellent computer skills and working knowledge of Microsoft Office, Outlook, Word, and Excel.
• Must have excellent verbal, written, and interpersonal skills.
• Must be process oriented with great attention to detail.
• Must be able to manage and appropriately prioritize multiple tasks at the same time.
• Must be detail oriented and capable of working with minimal supervision.
  
  

Education

• Must have High School Diploma or GED equivalent.
• Equivalent combinations of education and experience may be considered.
  
  

Work Environment

• Remote: This role is a remote (work from home (WFH) opportunity) and only open to candidates currently located in the United States and able to work without sponsorship.
• It requires a suitable space that provides a private and quiet workplace.
• Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
• Travel: May be required to travel to off-site location(s) to attend meetings, as necessary
• Hourly Pay Range: $26.00/hr - $35.00/hr and a strong comprehensive benefits package, dont forget to follow the link to our benefits page for details, too many benefits to list! EMPLOYERS Benefits
  
  

About EMPLOYERS

As a dynamic, fast-growing provider of workers compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work!

We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS!

Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees.

We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other!

At EMPLOYERS, you’ll discover an energetic environment that inspires top achievement. As “America’s small business insurance specialist”, we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. About EMPLOYERS

---