Workers Compensation Compliance Specialist

📋 Description

• Establishes and nurtures relationships with state regulatory bodies to enhance the company's reputation and standing within the respective state(s).

• Maintains an up-to-date understanding of the state regulatory framework and stays informed about changes and improvements to the state regulatory fee schedule.

• Identifies, develops, and aids in the implementation of training for colleagues on compliance issues related to state systems and enhancements in medical bill review.

• Recognizes necessary enhancements to the bill review system to bolster compliance and submits requests for these improvements as needed.

• Collaborates with state workers' compensation agencies as required.

• Generates necessary reports on claims, penalties, and compliance matters to ensure adherence within the state(s).

• Serves as the main point of contact between the company and carrier partners concerning specific penalty issues within the jurisdiction.

• Assists in providing targeted compliance training specific to the jurisdiction.

⛳️ Requirements

• A bachelor's degree from an accredited institution is preferred.

• A minimum of four (4) years of relevant experience or a comparable combination of education and experience is required.

• Preferred experience in claims management, call center operations, medical bill review, or managed care.

• In-depth knowledge of state regulatory compliance standards.

• Familiarity with claim management systems.

• Proficient in PC operations, including Microsoft Office applications.

• Possesses strong analytical and interpretative skills.

• Excellent organizational abilities.

• Strong interpersonal communication skills.

• Capable of working independently as well as collaboratively in a team setting.

🏝️ Benefits

• A choice of three medical plans and two dental plans.

• Eligibility for tuition reimbursement.

• A 401K plan that matches 50% of every dollar contributed up to the first 6% saved.

• Four weeks of paid time off (PTO) in your first full year.