EDI Supervisor

EDI Supervisor

Requirements

• High school diploma or GED required
• Bachelor’s degree preferred
• Minimum 3 years of experience in worker’s compensation positions related to claims EDI data required
• Minimum 2 years of professional experience with the MS Office suite including Excel required
• Must be proficient in Microsoft Word, Excel, and Outlook
• Specific functional knowledge related to electronic data interchange principles required
• Understanding of insurance claims principles and practices
• Must possess advanced data entry skills with the ability to learn enterprise and department specific applications
• Must possess analytical and problem-solving skills with particular attention to detail required
• Excellent verbal and written communication, time management, task management, and organizational skills
• Ability to lead a team and delegate tasks

Responsibilities

• Oversees EDI operations to multiple reporting agencies to ensure compliance with regulatory standards
• Monitor compliance for multiple reporting agencies including Medicare reporting, Reinsurance reporting, FROI/SROI reporting, Indemnity Data Call (IDC) reporting
• Processes the most complex issues and filings and monitors performance to ensure state timeline and acceptance rate standards are met
• Establishes controls to ensure quality workflow within the EDI traffic flow and innovatively drives changes for continuous improvement to exceed expectations
• Tracks and reports statistics to the department leadership to help them evaluate department performance
• Audits and ensures correction of incorrect account information in submissions and databases
• Evaluates staff assignments for accuracy, quality and completeness ensuring deliverables are within the established processes and schedules
• Remains updated on industry communications and changes in legislation regarding FROI/SROI, Medicare and IDC reporting to implement changes and communicate information to stakeholders
• Develops and conducts training for EDI Administrators and other departments
• Maintains guidelines to ensure all documentation and procedures are current and accurate
• Creates and maintains electronic and in person training material and curriculum
• Schedules training classes, tracks attendance and reports on training and attendance results
• Establishes relationships with other departments to enhance communication and efficiency across the organization and facilitates training to various audiences better meet client and company needs
• Acts as subject matter expert (SME) on EDI projects including scoping, analyzing and executing
• Develops policies and processes for EDI technology and develops testing plans and coordinates with technology teams on automated EDI transaction and document issues
• Develops and continually updates work flows for transaction submissions referenced by the worker’s compensation claims and technology departments
• Develops training materials, documentation, and recommendations to EDI staff concerning submission processes
• Creates project plans within the department and is accountable for project activities and assigned objectives of the EDI team
• Provides daily direction to EDI team
• Communicates Mission, Values, and other organization operating principles to direct reports
• Establishes and maintains the overall work cadence, in partnership with department leadership
• Ensures performance and outcomes strive for excellence in delivery and customer experience
• Ensures that the entire team is engaged and that leadership practices in the department encourage development, recognition, and retention
• Establishes and adheres to hiring criteria, on-boarding, and training requirements for incoming staff
• Oversees the performance management and development process for the team and performs performance management duties, development planning, and coaching for direct reports
• Acts as a resource for team members to answer questions and solve complex problems
• Manages workload and customer requests for EDI services
• Ensures adherence to all Company policies and procedures and compliance responsibilities
• Ensures data quality, adherence to department guidelines, and other metrics for self and members of the team

Preferred Qualifications

• Supervisory experience preferred
• International Association of Industrial Accident Boards and Commissions (IAIABC) EDI Claims Professional designation preferred