Senior Workers' Compensation Claims EDI Specialist - Temp/Remote

Position Summary

The Workers’ Compensation EDI Specialist will partner with Claims Operations and Adjusters to identify, research, and resolve Electronic Data Interchange (EDI) and CMS Section 111 reporting errors across workers’ compensation claims. This role is fully focused on data accuracy, error resolution, and compliance support and does not carry an active claims caseload.

The ideal candidate will bring strong workers’ compensation knowledge, exceptional attention to detail, and the ability to independently investigate and correct data issues across multiple systems and external reporting platforms.

Compensation:

• $45.00 - $65.00/year(based on experience)
• Opportunity to work with a reputable insurance carrier known for a collaborative and supportive culture
• Comprehensive benefits package including medical, dental, and vision
• Opportunities for career growth within a stable and respected insurance organization.
• 100% remote work environment

Responsibilities

• Partner with Claims Operations and Adjusters to identify and resolve EDI and CMS Section 111 reporting errors.
• Research missing or inaccurate claim data fields across multiple claims systems and external reporting portals.
• Communicate with Adjusters, claimants, insureds, or other stakeholders to obtain required information for correction and compliance.
• Accurately update, correct, and validate claim data within internal systems and state or federal reporting platforms.
• Ensure all corrections align with regulatory requirements, reporting standards, and internal data integrity guidelines.
• Review and validate error corrections for completeness and accuracy prior to submission or closure.
• Maintain organized documentation of findings, corrections, and resolution steps.
• Support Claims Operations in improving overall data quality and reporting accuracy.

Requirements

• 5+ years of workers’ compensation claims handling experience and EDI/CMS Section 111 reporting experience.
• Strong understanding of workers’ compensation claim structure and data elements.
• Excellent attention to detail with a high degree of accuracy in data entry and validation.
• Strong investigative and problem-solving skills with a tenacious approach to resolving data gaps.
• Ability to work independently in a remote, fast-paced environment.
• Strong communication skills, including the ability to interact with internal teams and external stakeholders.
• Demonstrated accountability, reliability, and commitment to high-quality work output.

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

#LI-MW1