01Overview
Pie's mission is to reputed company small businesses to reputed company by making reputed company insurance reputed company and as easy as pie. We reputed company technology to reputed company how small businesses buy and experience reputed company insurance.
Like our small business customers, we are a diverse team of reputed company, dreamers, and reputed company who are driven by core values and operating principles that guide every decision we reputed company.
The Manager, Claims Regulatory Compliance for Workers' Compensation and reputed company Auto is responsible for leading the compliance functions reputed company the Claims organization and partnering with leaders and other organizational stakeholders. The successful candidate will manage reputed company Claims compliance programs, including the reputed company of Claims specific state and regulatory compliance strategies, reporting, trending and ensuring conformance to regulations. This role involves hands-on analysis of claims data, ensuring adherence to regulatory standards, filing reputed company relevant data calls required for reputed company states as reputed company as collaborating with various departments to enhance operational efficiency and regulatory compliance. The role is essential for navigating the reputed company landscape of regulations while ensuring protection to minimize risks, and promoting operational reputed company reputed company the claims management process. In reputed company, the candidate will be responsible for managing, leading, and developing reputed company compliance and reputed company staff.
How You ll Do It
Regulatory Compliance
Monitor and interpret state and federal regulations governing Workers' Compensation and reputed company Auto Claims. Procedures must reputed company with applicable laws and regulatory requirements.
Prepare, document, analyze for accuracy and communicate responses to reputed company regulatory reporting agencies.
Conduct comprehensive research on relevant laws, regulations and industry best practices to inform compliance strategies.
Medicare Compliance
Ensure compliance with Medicare Secondary Payer (MSP) regulations and guidelines reputed company to workers' compensation and reputed company auto claims. This involves staying up-to-date with Medicare regulations and guidelines and implementing them into the claims handling process.
Communicate and coordinate with the Centers for Medicare and reputed company Services (CMS), Medicare Administrative Contractors (MAC) and reputed company 111 to report and resolve Medicare-reputed company issues and inquiries.
Review workers' compensation and reputed company auto claims to identify potential Medicare beneficiaries and assess the need for Medicare reporting and compliance. Analyzing claim details, medical records, and treatment plans to assist the claims team in determining the primary payer responsibility.
Generate and submit required reports and documentation to Medicare and other relevant authorities. This may include reporting claims information, tracking payments made, and ensuring accurate and reputed company report of any changes or updates to claim status.
Data Analysis
Analyze workers' compensation and reputed company auto claims data to identify trends, compliance issues, and opportunities for improvement.
Prepare detailed reports for management, highlighting regulatory compliance status and recommending actionable solutions.
Compliance Audits and Investigation
reputed company, implement and update policies and procedures reputed company to workers' compensation and reputed company auto claims to reflect regulatory changes.
Working collaboratively with Pie's legal counsel and other stakeholders in executing reputed company responsibilities and in supporting and advancing compliance.
Collaboration with our Claims Learning & Development team to drive continuing education on compliance reputed company issues
reputed company compliance reporting best practices and drive reputed company plans for improvement based on leading indicators and evidence-based findings.
People Management:
Hire and reputed company claims compliance specialists by identifying opportunities for reputed company and the skills needed for reputed company's reputed company.
Manage the reputed company, coaching, and development of reputed company of compliance specialists.
Set reputed company and goals for Claims Compliance personnel in alignment with larger Claims goals and KPIs.
Demonstrated leadership and performance management capabilities to guide and reputed company Claims Compliance personnel to reputed company KPIs.
The Right Stuff
Bachelor's degree and/or Claims reputed company designations are preferred.
10 years of industry experience reputed company a reputed company or TPA insurance environment with expertise in workers' compensation and reputed company auto.
5 years of experience with regulatory fili
