The Regulatory and Resource Advisor role provides support to ensure adherence with specific state requirements for Workers Compensation Claims by serving as the subject matter expert for all regulatory matters. The role will facilitate training and complete review/audits measuring compliance with jurisdictional regulations in accordance to Industry best practices and established claims handling requirements.
This position will work in conjunction with the WC Zone Claims management team to assure the zone is compliant with the extensive regulatory requirements within the state’s workers compensation arena, as well as the multiple legal decisions that can affect the outcome of claims handling on a go forward basis. Responsibilities
- Serves as the subject matter expert for the local field offices for all state specific regulatory matters.
- Maintains a full understanding of board rules, case decisions and pertinent findings that impact carrier requirements, need for training and improvement plans
- Completes the daily review of all exception reports to pro-actively identify potential violations in advance and remedy (i.e. timely first and subsequent payment report, medical bill payment report, etc.)
- Conducts self-assessments of indemnity claims to ensure compliance with state rules / regulations
- Conducts regular, jurisdictionally appropriate mock reviews mirroring actual State audit protocols and file pulls
- Completes targeted compliance and regulatory training such as proper calculation of wage rates, training in response to changes to board rules and case decisions
- Provides new examiner training for state specific regulatory requirements, workflow processes and claims handling (per state rules / regulations)
- Conducts special reviews to identify process breakdowns and to assess targeted file quality opportunities
- Prepares course material for training as assigned and delivers training.
- Performs desk level reviews such as reserves-review files to assure TTD, PD exposure is properly identified, UR\IMR compliance reviews
- Produces office level and Zonal action plans and partners with leadership to achieve timely and thorough execution leading to desired improvements
- Executes special projects as assigned by the managers in support of Zonal objectives as well as participation in national projects at the direction of the Operations team leaders
- Works in partnership with other Zonal leaders to maximize the use of data for analysis, reporting, and the ongoing development of dashboards and scorecards
- Continually seeks to improve the processes utilized to assess regulatory compliance and quality
- College degree or equivalent experience.
- 5+ years WC Claims handling experience
- Ability to interpret and provide guidance on case decisions
- Ability to develop required training materials and deliver desk level training
- Strong attention to detail
- Demonstrated ability to communicate with others
- Effective at gathering information and understanding of technical information
- Strong data and analytical skills including the ability to clearly and concisely share findings through written and verbal communications including producing management reporting
- Knowledge of insurance law
- Strong understanding of Microsoft office suite with intermediate level Excel and PowerPoint skills
- Team player
- As an individual contributor, demonstrate the ability to influence others in a matrix reporting environment
What We Offer:
AmTrust Financial Services offers a great work environment, competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical and Dental Plans, Life Insurance, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, and Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.