Support Service Delivery, Operations and Leadership on Workers Compensation and Automobile fee schedule compliance. Investigate cases in Salesforce, identify automation gaps, perform state audits, track and report case metrics, and engage implementation analysts for issues.
Role: Regulatory Compliance Analyst II
Role Summary
A results-driven Business Analyst responsible for supporting Service Delivery, Operations and Leadership by investigating questions regarding Workers Compensation and Automobile Fee Schedule Compliance. In this role, you will be responsible for identifying automation gaps and explaining fee schedule rule interpretation.
Key Responsibilities
- Subject Matter Expert in Workers Compensation and Automobile Fee Schedule Rules and Regulations
- Help to identify Workers Compensation and Automobile compliance gaps
- Respond to SalesForce cases from Clients, Service Delivery and Operations regarding questions on pricing and rules for assigned states within SLA guidelines
- Engage the state implementation Business Analysts when potential issues are identified
- Track Case production in a weekly tracker that will need to be submitted to the manager weekly
- Perform audits for assigned states when new fee schedules are adopted and implemented
- Weekly reporting on case submission metrics via SalesForce
Required Qualifications
- 5+ years of experience as a Business Analyst or Operations/Bill Processing
- Ability to demonstrate and communicate system automation
- Strong understanding of fee schedules research
- Strong analytical and problem-solving skills with high attention to detail
Preferred Experience
- Experience in reading and interpreting fee schedules
- Experience in healthcare operations and quality improvement initiative
- Strong time management skills
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