EDI Administrator

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and it’s our change agents who will help us continue to deliver our mission to create the best insurance experience possible.

The purpose of this job is to support the Electronic Data Interchange (EDI) program, through handling compliance for multiple jurisdictions across multiple lines of business by ensuring performance standards are met, efficiency of reporting and data quality. This role provides support to the internal Claims team, along with other analytical and project-based support functions within the department in support of business and company goals.

• Collects, organizes, and analyzes workers’ compensation data including claim data, financial data, and other relevant information based upon requests.
• Assists in the completion of data calls or targeted audits by collecting and preparing information.
• Completes various types of research on a regular basis for changes in regulations and as requested by external auditors.
• Documents and maintains workflows and procedures on the various components of EDI reporting.
• Maintains current knowledge of policies, procedures, and reporting operations across Medicare, reinsurance ceding, FROI/SROI, and IDC reporting to support compliance standards.
• Provides subject matter expertise in areas including FROI/SROI and Medicare Section 111 reporting.
• Complies with regulatory requirements and company rules.
• Stays updated on industry communications and changes in legislation to support changes regarding Medicare and other regulatory changes to communicate information to stakeholders and support changes.
• Assists with special projects assigned by management.

• Reconciles daily FROI/SROI diaries to ensure timely and successful transmission of claims data to various reporting agencies.
• Completes various forms of transactional tracking to ensure efficiency, timeliness and accuracy of reporting.
• Supports Medicare Secondary Payer Act processes and compliance with all state regulations.
• Analyzes and validates data at the time of submission, corrects errors and troubleshoots issues with documentation or vendors.
• Notifies and works with appropriate Claims Team Members to resolve errors.
• Identifies workflow and system gaps and reports to management.
• Maintains and manages EDI documentation of workflows to ensure accuracy and consistency with stakeholders to address data discrepancies.
• Handles errors to ensure accurate and timely reporting of EDI transactions.
• Distributes reports to management according to department procedures and policies.

• Reconciles daily FROI/SROI diaries to ensure timely and successful transmission of claims data to various reporting agencies (including Medicare and rating bureaus).
• Analyzes and validates data at the time of submission to ensure accuracy and completeness, and coordinates with stakeholders to address data discrepancies.
• Partners with the Claims team to resolve errors and provide support on EDI processes, protocols, and system usage.
• Monitors EDI queue and assists in clearing backlog diaries, emails, and issues as needed in support of the Supervisor.
• Supports monthly and quarterly Section 111 CMS Reporting as needed.
• Distributes reports to appropriate teams according to department procedures and policies.

• Identifies workflow and system gaps and recommends changes for process improvement.
• Assists in conducting internal audits to identify areas of non‑compliance and report to Audit & Compliance Manager to rectify issues.
• Identifies data integrity discrepancies and participates in correcting/implementing…