Regulatory Data Reporting Tech I/II

SUMMARY:

Performs data reporting as required by rating bureaus, state insurance departments, and similar regulatory entities. Responsible for enterprise-level collection, organization, and reporting of Workers Compensation claim, policy, and related data for all states , verifying data integrity, and correcting data as needed. Responsible for the completion and follow through on all customer requests, including internal and external. Contacts include internal department staff, agents, policyholders, and regulatory agencies. Assists in other reporting tasks as assigned. Performs ad-hoc data requests when necessary.

 

PRIMARY RESPONSIBILITIES: 

The levels are progressive and build on the previous level’s responsibilities and tasks.

Technician I

· Responsible for the timely submission of regulatory data filings.

· Serves as back up liaison for correspondence with regulatory agencies and agents, relating to regulatory data reporting.

· Runs reports on time cycles as required.

· Creates and/or edits submission files either manually or through the use of department applications.

· Creates and submits correction reports to data collection organizations (DCO) as necessary to resolve crits/errors or respond to customer request.

· Categorizes and distributes departmental mail.

· Assists in investigating and resolving source system issues that cause errors on regulatory data submissions.

· Assists in investigating the cause of fines relative to regulatory reporting. Reconciles checks against DCO invoices, tracks paid invoices, and sends checks to appropriate data collection organization

· Works with various internal department staff to correct claim and policy data as needed.

 

Technician II

· Includes all responsibilities of Technician I

· Primary liaison for correspondence with regulatory agencies and agents, relating to regulatory data reporting

· Primary liaison for production processes and/or issues related to regulatory data reporting

· Trains and mentors Technician I and provides feedback to management.

· Assists in preparing test cases for system changes related to regulatory data reporting; participates in the evaluation and approval of test data as needed

· Verifies programs are meeting regulatory requirements through development, testing and implementation stages; recommends program modifications to management as needed.

· Tests newly developed department applications

· Designs and monitors data quality checks for data submissions through the use of multiple applications

· Primary company contact for internal inquiries related to regulatory data reporting

· Resolves escalated cases from Technician I

· Investigates the root cause of fines relative to regulatory data reporting, develops and documents workflows, job aids, and regulatory reporting documentation

· Submits invoices for regulatory fines to Accounts Payable for payment

· Works with IT contacts both in-house and contracted, if applicable, to ensure data reporting programs are working appropriately.

· Updates task manager planner checklists by required due date.

· Performs duties related to all regulatory data reporting functions, including WCSTAT, WCPOLS, MDC, IDC, and DCI reporting

· Keeps apprised of changing industry requirements for data submission from regulatory agencies

· Works with DCO representatives and agents to correct claims and/or policy data as needed.

· Works under minimum supervision.

This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.

 

EMPLOYMENT QUALIFICATIONS:

A. EDUCATION REQUIRED:

Technician I & II

Associates Degree in insurance and/or related field. Combinations of education and experience may be considered in lieu of formal education.

 

B. EXPERIENCE REQUIRED: 

Technician I

Minimum two (2) years’ experience with AF Group in billing, claims, policy/UW support, premium audit or equivalent AF Group experience that provides the necessary skills.

OR

Bachelor’s degree in business, insurance, math or related field.

 

And

Two (2) years’ relevant experience in a highly regulated industry such as insurance. Specifically as it relates to rules, procedures and regulations, policy and audit information i.e., reviewing, maintaining compliance with bureau rules and regulations or equivalent governing body.

 

Additional experience required for a Technician II

One (1) year as a Technician I, including experience with business systems support, systems development / testing, demonstrated technical decision making and interpretation of data collection organization (DCO) reporting rules, interpretation of and application of manual rules across multiple states and regulatory authorities.

 

 

C. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

Technician I

· Knowledge in computers and company standard software programs, with intermediate knowledge in Excel, Word, and Access.

· Ability to create reports utilizing Excel programs.

· Ability to clearly and concisely communicate factual and technical information, written and orally.

· Ability to proofread documents for accuracy of spelling, grammar, punctuation and format.

· Ability to organize, prepare, analyze and interpret data to find and solve problems.

· Basic knowledge of the insurance business and other departments’ functionality.

· Ability to correlate business processes with impacts to source systems and data used in bureau reporting.

· Ability to identify situations requiring intervention and take appropriate actions.

· Ability to document processes.

· Excellent oral and written communication skills.

· Ability to perform mathematical calculations and operate a ten-key adding machine.

· Ability to enter alpha/numeric data accurately.

· Ability to maintain confidentiality.

· Ability to work primarily independently.

· Ability to use independent judgment to remediate routine problems with submission files under general supervision of Supervisor, Regulatory Reporting or Technician II.

 

Technician II

· All skills of Technician I.

· Knowledge of WCSTAT and WCPOLS.

· Ability to comprehend the consequences of unusual situations and take appropriate actions and/or refer problems for necessary decision making.

· Thorough knowledge of the insurance business and other departments’ functionality.

· Strong knowledge of insurance procedures and ability to analyze workers compensation data.

· Ability to establish work flows, manage multiple projects, and meet necessary deadlines.

· Knowledge of differences between states regarding regulatory data reporting.

· Ability to understand specifics of data submission files for all states..

· Strong understanding of business processes (policy processing and/or claims processing) and how they impact source system data.

· Ability to use independent judgment to remediate most problems with submission files.

· Ability to troubleshoot issues that arise with submission files and/or corrections to assist in determining whether a manual work around is appropriate, a system fix is necessary, whether there is a training issue, etc. Ability to funnel the findings to appropriate leadership to follow up and assist determining suitable action.

· Ability to use Reports Portal and intermediate knowledge of EDW.

· Ability to create and use Reports Portal as necessary to support troubleshooting and external requests.

· Ability to have increased contact with vendors regarding system issues and assist in resolution of issues.

· Understanding of regulatory data reporting workflows.

· Ability to troubleshoot or analyze moderately complex data or scenarios and determine corrective actions.

 

D. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED: 

Technician I

· An insurance designation or working towards insurance designation or accreditation preferred.

· Ability to troubleshoot or analyze moderately complex data or scenarios and determine corrective actions.

 

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Travel required as necessary.

 

REQUIRED TESTING: 

Reading Comprehension, Alpha Numeric, 10-Key, Math, Intermediate Word, Intermediate Excel, Intermediate Access, Intermediate Windows and Proofreading