Insurance Compliance Analyst -Revenue-Insurance -Kanawha

This job opportunity is not in the classified service and is not covered by the West Virginia Division of Personnel merit system.

Nature of Work

Workers' Compensation - Claims Services

900 Pennsylvania Avenue, Charleston, WV 25302

The Claims Services unit within the Workers' Compensation division of the WV Offices of the Insurance Commissioner (OIC) provides oversight and support of multiple workers' compensation programs.

• Reviews, research, and addresses any identifying issues in the Occupational Pneumoconiosis (OP) examination applications and fatal reviews from the Workers’ Compensation insurance carriers, third-party administrators (TPAs), and self-insured employers.
• Conducts extensive claims history reviews for the OP Board examination, including the calculation of prior impairment ratings.
• Provides appointment notifications and follow-up contact with OP Board Clinic, insurance carriers, TPAs, and self-insured employers; scheduling consists of approximately 7 OP Board dockets per month.
• Reviews and distributes the OP Board findings from the OP Board Clinic received on the OIC’s secure website portal to all related parties in the claim.
• Develop recommendations to approve or deny requests from third-party administrators to change the claim reserves on individual claims by an amount greater than, or equal to, $100,000.
• Reviews and processes the EDI related Trading Partner Profiles within twenty-four (24) hours of receipt.
• Emails subsequent report of injury exceptions to insurers for resolution.
• Answers phone calls regarding issues from claimants, such as payment issues, death acknowledgements, claim forms, and any issues with the TPA.
• Reviews new claim submissions, establishes the new claim, and generates the jurisdiction claim number (JCN); responsible for then sending the established claim to the TPA for administration.
• Reviews and resolves claim benefit payment issues.
• Performs other duties as assigned.

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Training: Bachelor’s degree from an accredited college or university.

OR Substitution:
Additional qualifying experience as described below may be substituted for the required training at the rate of one (1) year of experience for every thirty (30) semester hours of education.

AND
Experience: Three (3) years of full-time or equivalent part-time paid professional experience in insurance, insurance regulation, collections, financial analysis, accounting, and/or a related field.

OR Substitution:
Master’s degree from an accredited college or university in a related field may substitute for two (2) years of the required experience.

Come join our team! We Believe Our Employees Deserve The Best To Make Sure They Have a Great Work-life Balance. The WV Offices Of The Insurance Commissioner Offers a Great Benefit Package That Includes:

• Holidays - Minimum of 12 paid holidays
• Leave Accrual - Ample Annual (starting at 4.61 hours a pay period) and Sick Leave (5.55 hours a pay period) Accrual
• Medical Insurance - Insurance through Public Employees Insurance Agency (PEIA) with several plan options and Flexible Benefits through Mountaineer Flex Benefits to cover additional needs
• Life Insurance - Free $10,000 Basic Life Insurance and additional life insurance offered at a low cost to you
• Retirement - Mandatory…