Transaction Data Specialist - Hybrid

The Workers' Compensation Insurance Rating Bureau of California (WCIRB) is California's trusted, objective provider of actuarially-based information and research, advisory pure premium rates, and educational services integral to a healthy workers' compensation system. The WCIRB is a California unincorporated, private, nonprofit association comprised of all companies licensed to transact workers' compensation insurance in California, and has over 400 member companies. No state money is used to fund its operations. The operations of the WCIRB are funded primarily by membership fees and assessments.

To accurately measure the cost of providing workers' compensation benefits, the WCIRB performs a number of functions, including collection of premium and loss data on every workers' compensation insurance policy, examination of policy documents, inspections of insured businesses, and test audits of insurer payroll audits and claims classification.

The WCIRB employs approximately 175 people. The home office is located in Oakland, California.

How you will make an impact

At the WCIRB, the Transaction Data Specialist is part of team that conducts high quality and innovative research to develop forward looking insights that inform stakeholders and advance the health of the California workers' compensation system. The Transaction Data Specialist applies their knowledge of business analytics, medical billing or medical coding to support the WCIRB's medical and indemnity transaction data collection, validation and education functions and assists in monitoring the timely and accurate collection of data to support ratemaking and research objectives.

Summary

The Transaction Data Specialist works with Actuarial and Research teams to develop a better understanding of the complexities of the indemnity and medical transaction data; sharing the uses and limitations, including data quality issues, of transaction data in WCIRB studies; suggesting trends and issues that merit investigation; explaining claim handling dynamics; and advising about the use of detailed claim data in research and modeling. The Transaction Data Specialist works directly with insurer personnel and their data submitters to resolve indemnity and medical transaction data reporting and data quality issues.

Essential Duties and Responsibilities

• Collaborates with the other members of the Transaction Data team to approve submitters for reporting, monitor data quality of the submissions and communicate known and evolving issues to the Actuarial and Research and other teams, as appropriate.


• Uses existing reports and develops additional reports as needed to analyze data quality.


• Assists data submitters in obtaining and understanding reporting requirements and actively works with submitters to report data accurately, efficiently, and timely.


• Works directly with insurer personnel and their data submitters to resolve complex data quality issues related to detailed transactional information.


• With the Associate Director, investigates and researches the quality of transaction data used in research and other studies.


• Provides business support for the development, testing and enhancement of the core WCIRB systems needed to collect, validate, warehouse, and access the transaction data.


• Supports the loading of necessary codes (such as taxonomy, place of service, HCPS, CPT) into the data warehouse and maintenance of data validation rules.


• Supports the development, maintenance, validation, and enhancement of transaction data- based products such as benchmark reports, data quality reports and notices.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education, Experience and Skills

• Bachelor's Degree (including completed courses in relevant areas such as health science, quantitative social science, public health, business administration, statistics, or communications)


• Minimum 1 year experience in California workers' compensation, medical bill review, medical coding or;


• Minimum 3 years of experience in other lines of insurance.[LC1] [DS2] [LC3]


• Excellent project management and planning skills.


• Ability to clearly communicate internally and externally, verbally and in writing, and in a professional manner.


• Ability to work collaboratively on projects.


• Demonstrated proficiency with understanding and interpreting analytical reports in a variety of data formats and summarizing the results of data analysis for technical and non-technical audiences.


• Demonstrated proficiency in data acquisition via business intelligence tools or SQL.

· Understanding medical terminology and ability to research coding related questions preferred.

• Familiarity with ICD-10, CPT, and HCPCS codes preferred.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Job requires both sitting at a workstation (90%) and moving about the office (10%).


• Significant time spent at a PC using a keyboard and/or mouse.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Sometimes highly paced, high stress environment.


• Job requires performing multiple tasks concurrently.


• Requires a cooperative and collaborative inclination.


• Work requires attention to detail, follow-through, and analysis of collected information.


• Extended hours may be required during major project deadlines.

Perks & Benefits

Our employees enjoy a state of the art, energy-efficient, open work environment that nurtures collaboration and creativity. At the WCIRB, we go the extra mile to keep our employees happy and healthy.

Our perks include:

• Hybrid work environment (40% onsite 60% remote)


• Allowance for wellness & fitness programs


• Medical, dental and vision benefits


• 401K and pension plan


• Annual incentive plan


• Social activities


• Community volunteer involvement

Disclaimer

Management may assign or reassign duties and responsibilities to this position at any time. As such, the job description may be revised depending on the WCIRB's needs. Further, this job description is a general summary of responsibilities and requirements and is not intended to be all-inclusive of the responsibilities and requirements of this position.

Please note that the WCIRB has enacted a mandatory COVID-19 vaccine requirement for all employees. Proof of full vaccination or an approved exemption or deferral is required of all employees, including new hires.