Workers' Compensation Claims Data Manager

Job Description

Job Description

Excalibur Insurance Management Services LLC is a governmental insurer serving all types of government, other than state government, including counties, cities, school districts, boroughs, townships, housing authorities, and other public authorities. Excalibur is the attorney-in-fact for H.A.R.I.E. (Housing and Redevelopment Insurance Exchange), which is organized as a reciprocal insurance company in Pennsylvania. All lines of coverage, for both property and casualty, are offered. It is Excalibur’s mission to provide high-quality coverage to all of its insureds, supplemented by exceptional integrity. A culture fostered by a strong sense of company values, purpose, and growth collectively is why Excalibur continues to fulfill and exceed the expectations of its clients. Excalibur has been providing insurance for local governments for 35 years.

Salary Range: Salary will be commensurate with experience and qualifications.

Job Responsibilities:

● Assist in the monitoring and handling of claims for all lines of business

● Management of Third-Party Administration (TPA) accounts/contracts

● Management of weekly claim reviews and payments, claim check payments

● Claim data collection and data reporting to state and federal agencies to ensure regulatory compliance

● Monitoring of federal and state regulatory updates

● Continuous improvements in claims handling procedures and software evaluation

● Management of claims handling software functionality and updates with vendors is essential for day-to-day operations

● Ensure adequate and accurate reserving practices; oversee reserve adequacy reviews and actuarial collaboration

● Communication with accounting and finance departments regarding projected loss settlements

● Assist the VP of Claims and in-house legal counsel with litigation management and subrogation/salvage

Insurance Software (InsurTech) and Computer Science Skills

● Oversee daily/quarterly/annual electronic submission of Workers’ Compensation detailed claim data (inc. Insurance Renewal Reports) to the Pennsylvania Dept of Workers’ Compensation via their online portal and EDI formats through WCAIS (Workers’ Compensation Automation and Integration System)

● Prepare and electronically file Medicare/Medicaid claim information via Verisk/MSP Navigator.

● Ensure accurate and timely submission of Medical & Indemnity Data Call reports to the PCRB (large-deductible and self-insured data, where applicable)

● Develop and monitor data quality rules and reconciliation reports to ensure a 100% match between carrier data and PCRB/NCOIL/NAIC submissions.

● Own the integration and testing of new PCRB reporting requirements (e.g., changes to Unit Stat file layouts, new data elements for opioid tracking or COVID claims)

● Automate the generation and electronic filing of Pennsylvania state-mandated reports (e.g., PA Insurance Department Financial Data Call, Catastrophe Reporting, TRIA reporting)

● Manage vendor relationships for data enrichment services

● Conduct root-cause analysis on PCRB rejection/error reports and implement permanent fixes in data capture or transformation logic with Town and Country Computer Services (TCCS)

● Stay current on Pennsylvania-specific regulatory changes (Act 44, Act 57 updates, new data calls) and translate them into technical requirements.

● Assist actuarial and finance teams by providing clean, reconciled datasets for rate filings, loss triangles, and experience mod calculations.

Education/Experience:

● A computer science or insurance technology and risk management degree is required

● In-depth knowledge and experience with Pennsylvania workers’ compensation claims handling practices, law, and regulations.

● Expertise in using various property and casualty insurance software and technologies, such as Vertafore and Verisk.

● Experience with reporting claims data to various federal and state agencies, such as WCAIS and the PCRB

● Preferred candidates should have an InsurTech or property and casualty (P&C) related credential from an accredited institution, such as the Chartered Property and Casualty Underwriter (CPCU) designation or the Professional InsurTech Certificate from FinTech Global.

Benefits/Vacation Time:

● Major medical, United Health Care, long-term disability, and vacation package.

Hours of Operation:

Monday through Friday 8:30 a.m. – 4:30 p.m

Family-owned, highly communicative, and collaborative culture. Opportunities for advancement and paid training for certification.

Company Description

Family-owned, highly communicative, and collaborative culture. Opportunities for advancement and paid training for certification.