REGULATORY ANALYST III - 43003123

Requisition No: 856217 

Agency: Financial Services

Working Title: REGULATORY ANALYST III - 43003123

 Pay Plan: Career Service

Position Number: 43003123 

Salary:  $41,561.52 - $87,237.36 

Posting Closing Date: 07/15/2025 

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*****OPEN COMPETITIVE EMPLOYMENT OPPORTUNITY*****

DIVISION: WORKERS’ COMPENSATION

BUREAU: MONITORING AND AUDIT

CITY: TALLAHASSEE

COUNTY: LEON

SPECIAL NOTES:

Four (4) years of experience in a relevant field (risk management, insurance, claims handling, medical billing and reporting, financial accounting, or auditing) is required.  A postsecondary degree may be used as an alternative for the years of experience on a year-for-year basis.

Preferences:

• Two (2) years of experience using Microsoft Office (Outlook, Word, Excel, and PowerPoint in a professional environment.
• Two (2) years of experience interpreting rules, regulations, policies, and procedures.
• Two (2) years of regulatory enforcement experience.
• Two (2) years of experience in workers’ compensation medical and claims data collection.
• Two (2) years of Electronic Data Interchange (EDI) knowledge and experience.
• Experience in International Association of Industrial Accident Boards and Commissions (IAIABC) Claims EDI Release 3.

This position requires a security background check, including fingerprint as a condition of employment.

Employees of the Department of Financial Services are paid on a monthly pay cycle.

Responses to qualifying questions must be clearly supported by the state application and any omission, falsification, or misrepresentation in the answering of the qualifying questions will be cause for immediate elimination from the selection process.

Minimum Qualifications for this position include the following REQUIRED ENTRY LEVEL KNOWLEDGE, SKILLS AND ABILITIES:

Ability to examine and evaluate data relating to a workers' compensation program, to understand and apply applicable rules, regulations, policies and procedures relating to a workers' compensation program; Knowledge of the methods of data collection and analysis;  Ability to collect, evaluate and analyze data to develop alternative recommendations, solve problems, document work flow and other activities relating to the improvement of management practices;  Ability to organize data into logical format for presentation in reports, documents and other written materials, to conduct fact find-solving techniques, to plan, organize and coordinate work assignments,  to communicate effectively, to establish and maintain effective working relationships with other.

OTHER KSAs (Incumbent may learn on job): Ability to apply/interpret W.C.  law, rules and other procedures in developing new and improved data management and collection activities.  

BRIEF DESCRIPTION OF DUTIES:

This is professional work providing management consulting services for the Division of Workers’ Compensation, Bureau of Monitoring and Audit, Insurer Reporting Services Section to improve management capabilities and operational procedures related to the design, management, documentation, and evaluation of processes involved in the collection, quality control, storage and reporting of medical and claims data collected by the Division. 

Responds to customer requests requiring extensive knowledge of workers’ compensation.  Performs work independently, subject to review by immediate supervisor and/or team leader. Promotes the Division’s medical and claims data programs through various marketing strategies, including Internet (web site), e-mail, telephone, presentations, and written correspondence.  Follows Department Internal Controls Policy and Bureau procedures/instructions to ensure confidential information accessed is secured and not disclosed outside of position duties.

Educates trading partners in program filing specifications.  Assure that data collection strategies meet their needs for monitoring carrier performance and assessing penalties for noncompliance.  Suggests system improvements to address those specific needs.  Monitors performance of servers involved in daily processing of electronic submissions in order to assure consistent functionality and adequate capacity in moving electronically submitted claims continuously through the system, without delays or backlogs.  Reports critical problems to supervisor and management when delays in resolution interfere with daily production.  Provides prompt technical assistance to medical data submitters.

Participates in meetings and teleconferences with Supervisor and EDI insurers to discuss EDI program deficiencies and expected outcomes.  *Creates and maintains documentation on various EDI transaction filing requirements for the State of Florida, including electronic filing manuals, data element requirements, edit matrixes, event criteria, program edits, trading partner agreements, etc. (FL EDI Implementation Manual). *Develops, reviews and edits written operating procedures, flow charts, position descriptions, training guides, etc. for EDI Team processes to ensure completeness, accuracy, and comprehension of content. Develops, reviews, and updates documentation for various instructional materials, articles for newsletters, presentations, and web site.  Responds to ad hoc requests from management, the legislature, and internal/external customers by extracting information from the medical database for analysis of trends, as needed, using appropriate software or coordinating with technical staff.  Prepares management reports related to processing of data, as needed. Maintains organized records of work performed.  Maintains a record of communications with individuals, teams, Division bureaus, ACHA, IAIABC, and other program users, including both internal and external customers.  Produces documents, letters, and other correspondence relating to the development and design of data (Medical, Claims and POC) collection systems, business issues, workflow diagrams, etc.

Reviews and analyzes state and national workers’ compensation medical and claims data collection programs for compliance with federal requirements, state statutes and associated rules, correlation with Division needs, and alignment with Division goals/objectives, in order to develop and maintain more efficient and effective data management systems.  *Evaluates and monitors, data collection and management capabilities and corresponding operational procedures and rules associated with medical and claims data collection processes. Tests program modifications requested to ensure compliance with program design. 

Creates procedures geared towards achieving increased reliability and accuracy of data collection efforts and consistency between various division electronic programs and computer systems, including the Division’s Integrated System database. Identifies the need for and recommends medical and Integrated program modifications.  Evaluates the impact of program amendments on Division operations and goals.  Detects and reports actual or possible encumbrances/obstacles in existing or planned programs and resultant consequences, if not changed.   *Recommends solutions and improvements to promote data collection and integrity for meeting operational objectives of the Division. Evaluates and measures the effectiveness of existing system designs against desired program objectives to determine if changes are necessary.  Conducts special studies, surveys and other issues impacting operating practices.  *Provides management consulting services to supervising administrator and other Division managerial personnel on business data needs, process improvements relating to Division rules, operating procedures, user guides, and other data management programs.

Participates in EDI teleconferences, meetings, and webinars with trading partners.  Assists supervisor with issues stemming from national EDI development committee meetings, e.g., address and reconcile concerns with format design and content (particularly Release III). Educates trading partners in EDI program filing specifications. Participates on other projects/teams aimed at furthering improved/standardized data quality and collection techniques and practices.  Performs work independently, subject to review by immediate supervisor.

 Performs related work as required.

If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended, or deemed ineligible depending upon the date of your retirement.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.  Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.  Certain service members may be eligible to receive waivers for postsecondary educational requirements.  Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.  Veterans’ Preference documentation requirements are available by clicking here.  All documentation is due by the close of the vacancy announcement.