Manages electronic data interchange (EDI) claim process; trains, directs and monitors the operations of the EDI claim process for all Branch Offices. Identifies state reporting requirements for Electronic Data Interchange (EDI) claim reporting. Oversees the transmission of mandated EDI claim reports on behalf of Broadspire’s carriers and clients to the state Workers’ Compensation divisions within specified time frames to avoid potential state fines and penalties.
Responsibilities Determines and directs the Claim department's responsibilities for EDI related requirements. Directs branch offices and other internal sources on EDI requirements, error corrections and conducts EDI training. Evaluates, communicates and writes business requirements for EDI regulatory requirements for Claim personnel and IT. Determines claim department EDI procedures to comply with governmental requirements; writes and oversees the writing and publishing of necessary EDI manual revisions.Directs the work assignment of EDI Specialists, assigns special projects, conducts random audits of EDI Specialists’ work quality, and develops and conducts training of EDI Specialists in order to maintain quality and productivity within the EDI unit.
Keeps abreast of new Workers’ Compensation EDI laws. This would include reviewing state websites, industry newsletters or regulatory announcements on EDI state requirements.
Reviews regulatory requirements, analyzes claim data, and instructs IT and Business Analysts and writes business requirements on what data needs to be extracted from claim systems and reported to state agencies. Works extensively with the IT department to evaluate EDI system problems and makes recommendations on how to correct them.
Reviews, creates, approves and signs state EDI Trading Partner agreements, state reports and other regulatory agreements on behalf of the company and/or clients as needed.
Acts as a liaison between Branch Claim Offices and State Agencies on EDI requirements. Represents the company at EDI/IAIABC meetings and participates on related research and/or project committees as called on.
Evaluates and determines cost/benefit analysis of potential operational or system changes requested through regulatory or industry actions; plans project approach on approved proposals.
Creates and submits EDI First and Subsequent reports of Injury into the WorkComp.Net system to be sent to the state Workers’ Compensation divisions. Researches Workers’ Compensation claims in claim systems for information needed to complete EDI claim reports.
Analyzes any EDI errors received from the state and makes corrections if needed as stipulated by the state requirements.
Assists in the preparation of Claim Operations’ budget in regards to EDI policy and procedure expenses.
Requirements Education equivalent to graduation from college or the equivalent in related work experience.Five or more years of progressive experience in claim services or the equivalent, demonstrating a thorough knowledge of computer entry and operations and claims services policies and procedures. Four or more years of multi-jurisdictional experience in EDI state reporting.Valid driver's license.Ability to travel to Branch Offices, Industry Meetings or to a State Insurance Department. Demonstrates effective and diplomatic oral and written communication.Demonstrate a comprehensive knowledge of EDI policy, procedure and practices.Demonstrates effective and diplomatic oral and written communication skills. About Us Why Crawford?
Because a claim is more than a number — it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community – one claim at a time.
At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us.
We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at www.crawco.com.
When you accept a job with Crawford, you become a part of the One Crawford family.
Our total compensation plans provide each of our employees with far more than just a great salaryPay and incentive plans that recognize performance excellenceBenefit programs that empower financial, physical, and mental wellnessTraining programs that promote continuous learning and career progression while enhancing job performanceSustainability programs that give back to the communities in which we live and workA culture of respect, collaboration, entrepreneurial spirit and inclusion
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.
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