The Corporate EDI Specialist is responsible for implementing techniques to reduce the financial impact and increase acceptance rate of state electronic reporting. This role provides high-level EDI support to the local claim teams, focused on proactive claim management approaches to ensure compliance in accordance with the jurisdictional requirements.

• Review EDI Report daily to determine the rejection cause and collaborate with the adjuster to facilitate corrective action for timely resubmission; deliver feedback and coaching opportunities to the appropriate parties if trends are identified.
• Review daily strategic proactive measurement reports; distribute to adjuster and supervisor and maintain appropriate follow up activities to ensure timely claim actions and EDI transactions.
• Design and implement scorecards to evaluate the trends that are driving EDI fines and penalties; calibrate scorecards on a monthly and quarterly basis.
• Provide root cause analysis and consequence assessment to TPA Claims Compliance Manager and Regional leadership monthly and quarterly; recommend a systemic approach to improve results within the span of control at the desk level.
• Coordinate quarterly conference calls with the claim teams to provide a high-level overview of the EDI results, along with strategies to improve compliance in the following quarter.
• Review monthly Acceptance Rate score from the state; investigate non-compliance causes and establish action plans to achieve 90% goal.
• Attend all meetings and conference calls with the state as scheduled.
• Provide strategic and technical training to new employees, and ongoing training at least quarterly to legacy employees; maintain detailed attendance records of all training sessions; including individual coaching and feedback discussions.
• Create quarterly newsletters and design workflow guides and job aides as necessary; communicate updates to all stakeholders.
• Collaborate with EDI Claims Operations as necessary.
• Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.
• Complete additional special projects, compliance initiatives and job duties as assigned.
• Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.