Hcc Risk Adjustment Coding Jobs in Michigan (NOW HIRING)

SUMMARY:
Primarily responsible for the following: Authority to evaluate which submitted vendor physical and phone audits and decide which require further analysis; approval, completion and processing mail audits; processing adjustments, and reviewing phone and physical audits requiring further review in a multi-functional business unit. Provides direct customer service via phone, fax, and e-mail to internal and external customers including, but not limited to; Business Development Consultants and Service Center representatives, Finance, and other Premium Audit staff, as well as agents, attorneys, NCCI / regulatory bureaus, and policyholders.
PRIMARY RESPONSIBILITIES:
• Actively engages in the identification of solutions for multiple or cross-functional business areas. Has an understanding of the direction of the overall industry and evaluates the related impact.
• Evaluate and decide in a timely manner which vendor audits submitted require further review and provide direction to the Premium Analyst position.
• Analyze, research, approve, complete and process mail audits.
• Review phone and physical audits for audit findings which need to be communicated to relevant internal staff, including but not limited to Business Development, Worksafe Consulting Services, and Claims to amend the policy accordingly.
• Analyze, research, approve, complete, and process the following audit adjustment types: waive, mail, phone, and physical audits. When an adjustment is denied, notify the parties involved.
• Make necessary customer contacts to an insured, accountant, or agent to gather sufficient information to ensure the classifications are correctly applied on the audit/audit adjustment. Identify correct classifications on the audit by using research tools such as, but not limited to PAAS, NCCI, and other applicable web tools.
• Analyze, research, and communicate policy changes and omissions to relevant internal staff that include, but are not limited to, payroll, class codes, entity, states, Federal/Risk IDs, addresses, officers, endorsements, as a result of audit findings while completing the audit/audit adjustment.
• Manage workflow inventory within PAM to achieve specific time service goals.
• Train and mentor the Premium Analyst I, II and Premium Audit Technician.
• Compose written correspondence, as appropriate.
• Maintain confidentiality of information processed.
• Work with minimum supervision.
EMPLOYMENT QUALIFICATIONS:
A. EDUCATION REQUIRED:.
Associate degree in Accounting, Business, Insurance, Finance, or a related field. Combinations of education and experience may be considered in lieu of a degree.
B. EXPERIENCE REQUIRED:
One year as a Premium Analyst II with demonstrated technical decision making, audit processing skills and demonstrated experience with manual rules across states and regulatory authorities. Four years technical or administrative office experience including relevant audit or payroll duties in an insurance organization or three years demonstrated experience of the necessary skills, knowledge, and abilities for the position, may be considered.
OR
Bachelor's degree in Accounting, Business, Insurance, Finance, or related field with progress towards or completion of Insurance Institute of America (IIA) or other insurance related designation(s)
And
One year as a Premium Analyst II with demonstrated technical decision making, audit processing skills and demonstrated experience with manual rules across states and regulatory authorities.
And
Two years technical or administrative office experience including relevant audit experience in an insurance organization or two years demonstrated experience of the necessary skills, knowledge and abilities for the position, may be considered.
C. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
• Understanding of vendor audit formats and processes, which facilitate making decisions in a timely manner regarding which audits will require further review by Premium Analyst II's.
• Ability to work effectively in a multi-functional business unit.
• Knowledge in the concepts and application of underwriting rules, procedures, state manual rules and Workers' Compensation classifications in all core states as well as an awareness of non-core states.
• Excellent oral and written communication skills.
• Excellent organizational skills and ability to prioritize work.
• Ability to manage multiple priorities and meet established deadlines.
• Basic knowledge of computers, word processing, and spreadsheet software with accurate input ability of 40 wpm and ability to use 10-key.
• Analytical and problem solving skills.
• Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format.
• Basic math skills.
• Proficient knowledge of payroll reports, payroll tax returns, tax forms and supporting documentation.
• Ability to think proactively and independently with a long-term perspective in addressing clients'/customers' needs.
• Understand and actively engage in the identification of solutions for multiple or cross-functional business areas. Has an understanding of the direction of the overall industry and evaluates the impact on own area of responsibility.
D. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED:
• Significant progress towards or completion of Insurance Institute of America (IIA) or other insurance-related designation(s) such as an Associate in Premium Audit (APA) or Chartered Property Casualty Underwriter (CPCU).
WORKING CONDITIONS:
Work is performed in an office setting with no unusual hazards.