State of Florida · 1 day ago
REGULATORY ANALYST IV - 43003529
Tallahassee, FL
Full-time
Onsite
Mid, Senior Level
$45K/yr - $95K/yr
4+ years expThe State of Florida is seeking a Regulatory Analyst IV for the Division of Workers’ Compensation, Bureau of Monitoring & Audit. The role involves providing management consulting services to improve operational procedures related to the collection and reporting of medical and claims data, conducting investigations, and ensuring compliance with regulations.
Government Administration
No H1B
U.S. Citizen Only
Responsibilities
Conducts investigations to acquire facts needed to issue penalty assessments against employers for violations of requirements for making timely benefit payments to injured workers and violations of document filing requirements
Monitors insurer/claim administrator late indemnity payments and late filings
Communicates by telephone or certified letter when penalty payments have not been made within the specified timeframes outlined in F.S. 440
Provides technical assistance and serves as a liaison to employers, employees, healthcare providers, attorneys, insurers and claim administrators with questions relating to the Workers’ Compensation law and claims handling practices
Educates insurers, employers and claim administrators regarding penalty assessments
Trains new and current CPS team members on WC processes and procedures, statute and rules, CPS and WC history
Responds to customer requests for extensive knowledge of workers’ compensation
Responsible for reviewing insurers performance for penalty violations more than $10,000 for three consecutive months
For those insurers that fall within this compliance issue, the Regulatory Analyst IV will ensure that a self-audit is conducted for the period of one year
Investigates complaints regarding violations of the law and Division Rules as assigned by the Regulatory Analyst Supervisor
Monitors carrier practices by identifying and documenting violation trends and provides recommendations to the Regulatory Analyst Supervisor
Investigates cases to determine questionable claims handling practices by claim administrators in accordance with Florida Statutes
Creates and maintains record of all actions taken and decisions issued for inclusion in any hearings before Judges of Compensation Claims, county court judges and statistical purposes
Provides detailed reports of progress and investigation results to the Regulatory Analyst Supervisor when needed to assist Legal in preparing cases for hearings
Identifies the need for and recommends CPS program modifications
Conducts testing for enhancements made to ensure compliance with program design
Assists the Regulatory Analyst Supervisor with evaluating the impact of program amendments on Division operations and goals
Assists the Regulatory Analyst Supervisor with conducting research to analyze program user needs, program hindrances, and other issues impacting operating practices
In conjunction with the Regulatory Analyst Supervisor, participates in team projects aimed at improving data collection techniques and practices
Reports critical problems to Regulatory Analyst Supervisor and management when delays in resolution interfere with daily production
Participates in meetings and teleconferences with Regulatory Analyst Supervisor to discuss program deficiencies and expected outcomes
Assists Regulatory Analyst Supervisor with responding to calls received on the Penalty ACD Line
Performs work independently, subject to review by Regulatory Analyst Supervisor
Follows Department Internal Controls Policy and Bureau procedures and/or instructions to ensure confidential information accessed is secured and not disclosed outside of position duties
Performs other related duties as required
Qualification
Required
Four (4) years of experience in a relevant field (risk management, insurance, claims handling, medical billing and reporting, financial accounting, or auditing) is required
A post-secondary degree from an accredited college or university may substitute for the required work experience
Two (2) or more years of regulatory experience
Two (2) or more years of experience working with Microsoft Office (Outlook, Word, Excel, and PowerPoint) and data analysis
Knowledge of and skill in utilizing investigative techniques; statutory coverage requirements of the Workers' Compensation Law (Chapter 440, Florida Statutes) and Florida Administrative Rules; ability to apply supervisor principles and practices
Ability to make and defend decisions regarding enforcement actions; to conduct fact-finding interviews and take statements; to evaluate and document performance of staff; to use deductive reasoning; to determine work priorities, assign work and ensure proper completion of work assignments; to analyze information and determine its validity; to prepare and conduct training programs; to prepare reports; to make independent decisions; to maintain strict confidentiality; to communicate effectively, verbally and in writing; to safely operate a motor vehicle, as evidenced by a valid driver's license; to understand and apply applicable rules, regulations, policies and procedures; to supervise people; to prioritize work load; to develop various reports; to assess budgetary needs; to collect, analyze and interpret data; to establish and maintain effective working relationships with others; to communicate effectively; to plan, organize and direct program activities
Skilled in the review and analysis of written correspondence
Preferred
Two (2) or more years of leadership experience
Two (2) or more years of experience interpreting rules, regulations, policies, and procedures
Two (2) or more years of experience in workers' compensation medical and claims data collection
Two (2) or more years of experience utilizing investigative techniques and practices
Two (2) or more years of Electronic Data Interchange (EDI) knowledge and experience
One (1) year of experience with international Association of Industrial Accident Boards and Commissions (IAIABC) Claims EDI Release 3
Company
State of Florida
The State of Florida is an online telephone and email directory for state government agencies and employees in Florida.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Richard Herstein, MD, MHA, MBA
Chief Hospital Administrator (CEO) and Chief Medical Officer (CMO)
Jimmy Patronis
Chief Financial Officer
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