EDI & Process Improvement Specialist

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.

**This position is eligible to work from home anywhere in the United States**

Essential Functions:

• Maintains high data quality standards across all projects and initiatives as related to EDI 
• Leads the process of ensuring all state specific requirements are appropriately tracked and implemented with vendor partner and within claims platform
• Performs thorough verification and validation of data entries to ensure accuracy and completeness
• Identifies, tracks, and rectifies discrepancies, inconsistencies, and errors in datasets through careful analysis and investigation
• Utilizes data management tools to conduct data verification processes efficiently
• Documents and reports findings, issues, and resolutions
• Maintains daily rejection and error reports to stay informed on the efficiency, timeliness, and accuracy of the claims EDI program
• Solves reporting errors or state criticisms and respond to inquiries regarding reporting matters
• Stays updated on industry trends, emerging technologies, and best practices related to data verification and quality assurance
• Proactively monitors proposed changes from states to their EDI process or order of items to be submitted.  Ensures implementation of necessary updates for EMC to remain in compliance 
• Collaborates with internal leadership and IT to monitor timely implementation of required system changes/upgrades, and vendor partners to facilitate data collection, resolve data-related queries and ensure effective use of vendors, communicating updates throughout the process
• Monitors reporting activity and assists in ensuring the timely completion of action items
• Monitors states where vendor support is not possible based on state requirements 
• Serves as the primary contact between EMC and vendor as audits occur. Recommends best practices to ensure alignment with state requirements as identified 
• Researches and tracks untimely filings resulting in penalties in multiple jurisdictions
• Identifies opportunities for process improvement to enhance the efficiency and effectiveness of the EDI workflow
• Ensures compliance with data reporting requirements set by regulatory agencies, ensures adherence to specific data instructions and standards, and timely submissions
• Collects, organizes, and analyzes data to report to claims team leadership
• Researches EDI compliance standards and maintains compliance workflows for all jurisdictions, where applicable
• Provides training and support to internal users on processes, protocols, proper utilization/efficiency implementation, and systems
• Participates in continuous improvement and efficiency initiatives aimed at optimizing data verification processes and workflows
• Maintains relationships with the claims team members and jurisdictional parties to ensure compliance and prompt responses to penalties imposed, where applicable
• Partners with Quality Assurance and WC Claims leadership to determine if issues persist and if targeted or large scale training is appropriate 
• Supports claim goals by leading, assisting and/or owning a process, special projects and assignments as directed by Claims Leadership

Education & Experience:

• Bachelor’s degree, preferably in business, project management or related field, or equivalent relevant experience 
• Five years of experience in claims adjusting, claims special programs, or related experience, including at least three years of experience with state EDI requirements
• Knowledge of state specific reporting requirements preferred
• Knowledge in understanding of the EDI Tables and implementation guides at state level

Knowledge, Skills & Abilities:

• Strong knowledge of workers compensation claims processes, claims handling, and workflows
• Good knowledge of computers
• Strong investigative and problem-solving abilities
• Ability to distill and communicate complex issues for technical and non-technical audience
• Ability to multi-task and prioritize deadlines
• Strong organizational, written and verbal communication skills
• Strong attention to detail
• Strong customer service skills
• Ability to adhere to high standards of professional conduct and code of ethics

The hiring salary range for this position will vary based on geographic location, falling within either the $77,013-$106,126 range or the $84,912-$117,001 range. A hiring range represents a subset of the full salary range.  The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs. 

Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.

All of our locations are tobacco free including in company vehicles.