Senior Claims EDI Specialist

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance.   Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make.

The Worker's Compensation Claims EDI Specialist will embody Pie's core values each day through service ensuring  seamless communication with the claims adjudicate teams while they navigate  the claims EDI filing process, ownership by taking charge of EDI efficiency, timeliness and accuracy, simplicity by streamlining our internal EDI procedures and making complex principles understandable, and by upholding a spirit of integrity ensuring adherence to jurisdictional requirements and data accuracy. The role will provide support for Pie's Workers’ Compensation claims organization handling multiple jurisdictions and data quality for reporting electronic transactions externally, as well as support to internal system users to assist with corrections for State Reporting

How You’ll Do It

• Reporting 
• Maintain daily EDI rejection and error reports to stay abreast on the efficiency, timeliness, and accuracy of the WC claims EDI program
• Reconcile EDI error reports and acknowledgement reports for EDI transmissions in multiple jurisdictions to ensure timely and successful transmission of claims data
• Collabroate with Enterprise Technology and the EDI vendor to solve system, feed, or correction issues
• Remain current on EDI rules and requirements, as well as IAIABC and state specific workers' compensation regulations and release updates.
• Monitor EDI specific areas of concern where compliance risk is high and reports to Claim Quality & Compliance Manager where there are issues of high risk / non-compliance.
• Compliance & Quality Control 
• Collecting, organizing and analyzing workers' compensation data to report to appropriate entity.  This includes but is not limited to gathering information from claim details, financial data, and other relevant data points.
• Ensuring compliance with data reporting requirements set by regulatory agencies.  Understanding and adhering to specific data call instructions, submission timelines, and data quality standards.
• Reviewing collected data to ensure accuracy, completeness and adherence to specificied data validation checks, resolving data discrepancies, and coordinating with stakeholders to address data quality issues.
• Ensure data confidentiality, security and compliance with data protection regulations.
• Root Cause & Trend Analysis
• Research and track First & Subsequent Report of Injury filings that have resulted in penalties for not recording timely in multiple jurisdictions.
• Continuous Improvement
• Identify opportunities for process improvement, automation and optimization to enhance the efficiency and effectiveness of the EDI workflow
• Providing training and support to internal users and external partners on EDI processes, protocols and system usage.
• Collaboration & Communication
• Partner and maintain relationships with the claims adjudicate teams and jurisdictional parties to ensure EDI compliance and prompt responses to penalties imposed, where applicable
• Research EDI compliance standards and maintain compliance workflows for all jurisdictions where Pie is licensed. Test, prepare, and maintain trading partner agreements with all current and new jurisdictions.
• Collaborating with internal teams, external stakeholders, and regulatory agencies to facilitate data collection, resolve data-related queriees and ensure effective communication throughout the data call process
• Support Claims Quality & Compliance team goals by assisting with special projects or tasks as directed by the Claim Quality & Compliance Manager

The Right Stuff

• 6-8 years experience in knowledge of workers’ compensation claims handling practices
• 3-5 years experience and knowledge with Electronic Data Interchange in multiple jurisdictions
• Knowledge of state specific reporting requirements preferred
• 3-5 years experience in understanding of the EDI Tables and implementation guides at state level
• Participation with an IAIABC committee a plus
• Exhibits deep knowledge regarding workers' compensation claims and EDI compliance requirements, as well the associate applications       
• Ability to research topics, organize information, and clearly communicate findings        
• Excellent verbal and wr