Technical Coordinator, Claims Systems and Analytics

The salary range for this job posting is $75,561.00 - $120,899.00 annually + bonus + benefits

The above represents the salary range for this job requisition. Ultimately, in determining your pay, we'll consider your location, education, experience, and other job-related factors. Your recruiter can share more information about the specific salary range during the hiring process.

This position may either work remote in our listed states or a hybrid schedule in the Charleston, West Virginia office. The position will report to the Director, Claims Systems and Analytics.

JOB OBJECTIVE:

The Technical Coordinator, Claims Systems and Analytics develops and performs statistical analyses using company data for the purpose of measuring claims outcomes. Utilizes industry standard reporting tools to establish claims dashboards and tools for the purpose of determining strategy and focus. Develops and implements predictive modeling tools and resources to assist the claims disciplines in early identification of red flags and strategy recommendations. Develops and assists in the implementation of new business requirements for new products, systems, and jurisdictions. This position serves as the administrator of the claims quality review system; and provides quarterly and annual analytics for the purposes of identifying areas that need improvement on the individual and team level. Ensures our products and systems are in regulatory compliance, efficient for the end user, and produces accurate calculations. This position utilizes expert knowledge of regulatory and jurisdictional requirements combined with innovative thinking to build systemic processes and effective claims management tools. This position analyzes quantitative and qualitative business indicators, makes recommendations for continuous improvement, and makes technical decisions in accordance with delegated authority.

ESSENTIAL FUNCTIONS:

• Develop claims expertise to regional business teams and other staff in areas such as policy, strategies, technical approaches, development of products and services, rules, filings, processes and workflows (including automation and business rules), regulatory compliance, and market conduct matters.
• Collaboratively manage system and data-related projects - including business requirements and timelines - that impact process, procedure, and best practices.
• Provide direction in the development of claims related tools and systems.
• Participate in the development and implementation of strategic and tactical product and system development initiatives based on trend monitoring, feedback from internal and external stakeholders.
• Present to and train internal and external stakeholders on product and service introductions, enhancements, and associated processes. Must demonstrate a solid understanding of the impact to internal and external stakeholders. Assist in the development of appropriate supporting materials.
• Gather and analyze our internal products, service product and service trends/results (internal) and make recommendations for new and revised products, and processes.
• Create innovative solutions using trend analysis; work with other disciplines to gather input regarding product and service changes and ideas.
• Effectively develop and utilize available data to make appropriate product and service development decisions and recommendations.
• Assist in the development of guidelines, policies and procedures that address identified business needs and support the achievement of business results. Determine system impacts resulting from process introductions or changes.
• Bring a solid understanding of compliance issues and regulatory environment in all project development and implementation.
• Identify and investigate compliance/regulatory issues and concerns. Develop and recommend appropriate business solutions and/or strategies based on those issues and analytical outcomes.
• Create and maintain other necessary claims administrative instructions and policy.

OTHER FUNCTIONS:

• Other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Bachelor's degree in Actuarial Science, Mathematics, Statistics, Business or related studies preferred.
• A minimum of one year of actuarial or analytical experience is preferred.
• Proficiency in Tableau or similar data tools preferred.
• Spreadsheet and database proficiency desired.
• Proficiency in SAS or SQL preferred.
• The preferred candidate has an ongoing pursuit of actuary or analytical credentials.
• Excellent written and oral communication skills needed.
• A minimum of five years full-time or equivalent part-time paid experience with an insurance carrier or equivalent program is preferred.
• Project management experience preferred.
• Ability to analyze data to form general rules or conclusions.
• Ability to understand and communicate regulatory requirements and develop claims best practices.
• Ability to use relevant information and sound judgment to determine whether processes or decisions comply with regulations or standards.
• Ability to work, coach, and mentor effectively in a team environment.
• Ability to establish and maintain effective working relationships with others.
• Ability to use logic and reasoning to identify problems, review related information and to analyze and compare alternative solutions, conclusions, or approaches, and to implement solutions and/or make improvements.
• Ability to learn and understand the form and content of insurance policies.
• Exceptional written and oral communication skills for use in internal team interaction and in collaboration with other business units for information gathering, reporting results, training, etc.
• Excellent analytical, research, and documentation skills.
• Ability to read, interpret, train and systematically apply regulatory requirements for a multi-state book of business.
• Ability to read and interpret financial statements.
• Ability to analyze and evaluate specific complaints and inquiries regarding claim-related issues such as benefit rates, medical authorization decisions, claims regulatory compliance, and timeliness of claim-related decisions.
• Effective organizational skills including the ability to manage multiple projects and work with minimal direction.
• Ability to become knowledgeable in the design, implementation and interfaces of systems and applications.
• Ability to apply confidentiality when appropriate.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Ability to work effectively in a paperless environment.

This position has been evaluated in accordance with the Americans with Disabilities Act. Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons.

Ready to join our team?
At Encova Insurance, we firmly believe that our associates drive our company's success by delivering unrivaled service to our customers. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating and financially rewarding opportunities.

Join us to discover a work experience where your diverse ideas will be met with enthusiasm - where you can learn and grow to your fullest potential.

What you can expect from us
Join our family of industry leaders, and let us reward you with a competitive salary, bonus and benefits package that includes but is not limited to: a 401(k), wellness programs, bonus incentive plans and flexible schedules, with an early close of the office every Friday. Additionally, Encova aspires to be an outstanding corporate citizen in all the markets we serve; we encourage and support associate participation in community initiatives through our foundations.

Encova Insurance is an EOE/E-Verify employer.