Compliance Examiner
Compliance Examiner
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1 Vacancy
Job Description
The work we do matters!
Hiring Agency:
Workers Compensation Court - Agency 37
Location:
Hiring Rate:
Job Posting:
Applications No Longer Accepted On (If no date is displayed job is posted as open until closed):
Job Description:
- Participate in developing implementing and maintaining systems to identify employers not having workers compensation insurance coverage.
- Respond to complaints from the public and referrals from the Compliance Program Assistant regarding lack of insurance coverage. Take appropriate corrective action including referral to the Nebraska Attorney General when appropriate.
- Respond to complaints and referrals regarding noncompliance with reporting and payment requirements claims handling practices and other obligations under the Act. Take appropriate corrective action including referral to the Nebraska Attorney General when appropriate.
- Testify before administrative and judicial bodies.
- Respond to inquiries from the public regarding workers compensation laws and rules.
- Research plan implement and maintain data collection for all compliance activities and results.
- Prepare and present information relating to workers compensation laws and rules to various groups agencies or organizations.
- Assist in evaluating statutes and rules. Recommend changes and draft proposals.
- Evaluate managed care plan applications coordinate review by other court staff as needed. Submit reports and recommendations to the Regulatory Programs Manager for review.
- Review amendments to contracts with and semi-annual and annual reports from certified managed care plans to ensure compliance with statutes and rules. Prepare reports for and recommend appropriate action to the Regulatory Programs manager.
- Assist in evaluating policies and procedures related to managed care including methods for monitoring effectiveness of certified plans. Recommend changes to the Regulatory Programs Manager.
- Participate in reviewing researching and implementing revisions to the DRG Schedule and the fee schedules adopted by the court.
- Respond to inquiries from court staff and the public related to managed care the fee schedules and other medical or medically related issues.
- Maintain list of independent medical examiners (IMEs).
- Respond to inquiries concerning IME statutes rules and procedures.
- Evaluate requests for assignment of an independent medical examiner and related information from other party(ies) and take appropriate action.
- Review independent medical examiner reports and evaluate and coordinate requests for clarification.
- Ensure compliance of all parties with IME statutes and Workers Compensation Court rules.
- Assist in evaluating the IME program. Report concerns and recommend solutions to the Regulatory Programs Manager.
Requirements / Qualifications
Minimum Qualifications: Bachelors degree or equivalent experience in the workers compensation field is required. Valid drivers license required.
Preferred Qualifications: Experience in investigations or customer relations preferred.
Other:
Experience in managed care operations medical cost containment programs hospital or medical clinic administration and/or health care delivery systems helpful. Experience in application of medical fee schedules the development and use of treatment standards medical peer review or utilization review helpful.
Knowledge Skills and Abilities:
- Skill in the use of word processing software.
- Skill in the use of database software.
- Skill in the use of spreadsheet software.
- Ability to create and maintain a positive working environment.
- Ability to exercise initiative and independent judgment within a broad framework of existing policies and procedures.
- Ability to recognize and suggest effective solutions for a variety of administrative problems.
- Ability to make and implement decisions effectively in accordance with established policies and procedures.
- Ability to interpret court policies and objectives for outside parties and the public.
Ability to maintain a variety of records and to prepare reports from such records.
Ability to communicate effectively both verbally and in writing including the ability to edit and compose complex letters memoranda and related materials.
Ability to maintain a high degree of confidentiality.
Ability to understand and accurately follow complex verbal and written instructions.
Ability to work on projects with only general supervision.
Ability to plan organize and prioritize individual work assignments and communicate the status of assignments.
Ability to work independently and as part of a team.
Ability to attend to detail.
Ability to meet deadlines.
Ability to handle multiple priorities and task assignments.
Ability to establish and maintain effective working relationships with court and/or state personnel at all levels and with the public.
Ability to follow established policies and procedures.
Ability to comply with established work schedules.
Ability to travel. Valid drivers license required.
Benefits
We offer a comprehensive package of pay benefits paid time off retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.
Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position agency and employment status. For more information on benefits please visit: Opportunity Statement
The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity inclusion and belonging. We recruit hire train and promote in all job classifications and at all levels without regard to race color religion sex. age national origin disability marital status or genetics.
Current employees of the State of Nebraska should NOT apply on this external career. Instead go to Workday and access the Jobs Hub - Internal Apply app from your home landing page.
Employment Type
Full-Time
