Regulatory Analyst II
State of Florida
full-time
Posted on:
Location Type: Office
Location: Tallahassee • Florida • United States
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Salary
💰 $40,320 per year
About the role
- This is work investigating and monitoring the business practices of insurance carriers, employers and servicing agents to ensure compliance with Workers’ Compensation law and procedures.
- Communicate by telephone or by certified demand letter for resolution when the penalized party has not paid or protested the assessment within the 20 days provided for in section 440.021, Florida Statutes.
- Conducts investigations to acquire facts needed to issue penalty assessments against employers for violations of requirements for making timely benefit payments to injured workers and violations of document filing requirements.
- Conducts investigations and monitors carrier/TPA late indemnity payments and late filings with the Division to acquire facts needed to issue penalty assessments, documents penalty claims reviews, and requests various forms required by law for claim clarification and/or correction.
- Credit payments to the proper case and request Department refunds when the assessment is incorrectly paid, or the claimant’s portion of the assessment is sent to the Department.
- Contacts by telephone employees, employers, insurance carriers/TPA’s, other Division of Workers’ Compensation Bureaus, attorneys, and other sources for information regarding employee/employer relationships, employer and carrier liability, claims process, etc., to determine validity of evidence to issue an action to reduce or revoke a penalty or deny a claim protest.
- Performs investigations of complaints regarding violations of the Workers’ Compensation Law and Division rules as assigned by the Insurance Administrator and assignments referred to the Penalty Section from other governmental agencies.
- Investigates and monitors Workers’ Compensation carrier practices, identifying and documenting patterns and trends of violation and recommends to the Insurance Administrator the action necessary to bring such practices into compliance.
- Provides interpretation of the Workers’ Compensation Law, rules, and procedures regarding penalty assessments and advises employers, carriers/TPA’s of their rights and responsibilities under the Law in effect on the date of an employee’s accident.
- Prepares and maintains a permanent record of all actions taken and decisions issued for inclusion in any hearings before Judges of Compensation Claims, county court judges, and statistical purposes.
- Assists legal office in preparing cases for hearings by preparing detailed reports of progress and investigation results, and attends hearings, providing testimony when necessary.
- Performs other related duties as required.
Requirements
- Two (2) years of experience in a relevant field (i.e. medical billing, medical reporting, risk management, insurance, claims handling, financial accounting or auditing) is required.
- A post-secondary degree from an accredited college or university may substitute for the required work experience.
- Preference s: Two (2) or more years of experience working with Microsoft Office.
- One (1) or more years of experience in medical billing, risk management, insurance claims handling, financial accounting or auditing.
- One (1) or more years of regulatory experience.
- One (1) or more years of Electronic Data Interchange knowledge and experience.
- One (1) or more years of workers’ compensation claims experience.
- This position requires a security background check, including fingerprint as a condition of employment.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical billingrisk managementinsurance claims handlingfinancial accountingauditingElectronic Data Interchangeworkers’ compensation claimscompliance investigationpenalty assessmentdocument filing
Soft Skills
communicationinvestigative skillsanalytical skillsattention to detailreport writingtestimony preparationproblem-solvinginterpersonal skillsorganizational skillsdecision making