Workers' Compensation Technical Services Team Lead

The WC Technical Services Team Lead is a hybrid role responsible for leading a team of 6-9 Electronic Data Interchange (EDI) Analysts and Repricing Associates while overseeing all aspects of the EDI and Repricing functions. Additionally, the position will handle provider fee disputes, EDI and Repricing projects, and directly support the daily goals of the EDI and Repricing teams. This position will report to the Workers’ Compensation Claims Manager.
 

Location: This is a full-time remote position. This position may require occasional travel to attend trainings or department meetings.
 

Job Responsibilities

The Team Lead will be responsible for, but not limited to:

• Submit FROI and SROI reports in a timely and accurate manner while also maintaining that the Electronic Data Interchange adheres to state-specific reporting requirements
• Daily tasks include data entry, investigating errors, collaborating with adjusters and identifying error trends
• Handle complex provider and other EDI or Repricing escalation calls
• Collaborate with vendor and IT to ensure systems meet 3.1 EDI update requirements
• Assist internal teams in ensuring compliance with Workers’ Compensation related state guidelines
• Investigate EDI and Repricing errors and assist team members with same
• Responsible for developing training materials and training team members
• Conduct team meetings, one on one conversations, and performance evaluations with EDI Analysts and Repricing Associates
• Act as a liaison between internal teams and bill review/EDI partners
• Research Workers’ Compensation claims in the claim system for information needed to complete EDI reports
• Analyze EDI errors and work the with claim adjusters to make necessary corrections as stipulated by state requirements
• Review state websites for filing information, potential penalties and fines
• Communicate with claims adjusting staff or other necessary internal staff regarding missing data
• Provide front line support for the Workers’ Compensation Claims Adjusting staff and leadership by answering low to highly complex EDI questions/issues and providing training
• Gain knowledge concerning rules, statutes and required forms for each state jurisdiction
• Prepare and deliver standard and/or ad hoc reporting and troubleshoot issues
• Continuously develop internal resources and documentation of standard operating procedures
• Actively contribute to the enhancement of internal processes by designing new reports and implementing improvements to existing tools and processes
• Research, respond and track inquiries in a timely manner to ensure compliance with state laws
• Handle EDI claim rejections and apply manual repricing as needed
• Process and administer reconsiderations and appeals while working with vendors and provider networks
• Research provider returned checks, research provider reimbursement inquires and process these requests
• Participate in vendor meetings
• Partner with bill review vendor to obtain an itemized report (sworn statement, affidavit or unsworn statement) to clarify the billing reviewed and correct calculation or fee schedule guidelines and rules for recommending an allowed amount
• Develop and maintain standardized processes and workflows for EDI and Repricing staff
• Perform other related duties as assigned
   

Qualifications

We are seeking candidates with the following:

• College degree or college level education
• Worker's compensation or Auto Casualty bill review experience preferred
• Intermediate skills in Microsoft Office (Word, Excel and PowerPoint)
• Ability to read and comprehend excel worksheets along with strong math skills
• Strong grammar and business writing skills for documentation and customer communication
• A solid understanding of billing, coding procedures, and medical terminology
• Ability to work within turnaround time standards and state law requirements and implement them in the Medical Bill Repricing and EDI processes
• Must be able to prepare comprehensive reports with little guidance
• High Level of Proficiency: excellent verbal/written communication, attention to detail and multi-tasking
• Approaches change as an opportunity for growth and development
• Ability to navigate multiple systems and screens simultaneously.
• Ability to work both independently and collaboratively within a virtual office environment
• Must have reliable internet
• Strong customer service skills
• Previous supervisory experience a plus
• Remote work experience with electronic records on a bill review platform a plus
• Coding Accreditations are a bonus
• Ability to work independently and meet assigned deadlines
• Highly attentive to details
• Self-motivator: works independently with minimal to moderate supervision
• Experience in Risk Management and/or Workers Comp with preferred prior experience/ knowledge of EDI a plus
   

About biBerk

biBerk is where commercial insurance buyers can obtain coverage for their businesses from insurers of the Berkshire Hathaway group of Insurance Companies, one of the best capitalized insurance groups in the world. Our ultimate parent, Berkshire Hathaway Inc. (berkshirehathaway.com) is a holding company with diversified interests in a host of industries, including insurance, energy, transportation and manufacturing. Most policies issued through biBERK.com will be underwritten by Berkshire Hathaway Direct Insurance Company ("BHDIC"), which is an AM Best rated A++ insurer.

BHDIC is domiciled in Omaha, Nebraska. BHDIC and the team at biBERK are focused on helping small business owners quickly and easily buy affordable insurance directly from a financially strong insurance company they can trust.
 

Some highlights of our benefits are:

• Great work environment with growth opportunity
• Competitive compensation
• Generous amounts of vacation and sick time
• Closed on major holidays
• 401(k) with company match
• A fantastic healthcare package
• Tuition reimbursement after 6 months of employment
   

In accordance with pay transparency laws and regulations, the following good faith compensation range estimate is being provided.  The starting salary range for this position is $80,000 to $90,000 per year.  Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law.