Senir Claims Compliance Analyst
Job Summary / Introduction
The Senior Claims Compliance Analyst is a senior, highly technical role supporting U.S. insurance claims operations in a complex, multi-jurisdictional environment. This position plays a critical role in strengthening claims governance, regulatory oversight, and compliance controls across all U.S. states and applicable federal requirements.
Detailed Job Description
- Own and support claims compliance oversight across all U.S. jurisdictions, including state and federal requirements.
- Monitor, interpret, and apply legislative, regulatory, and legal developments impacting claims handling.
- Translate regulatory change into operational guidance, policies, procedures, controls, and training materials.
- Maintain enterprise claims compliance documentation and jurisdiction-specific requirements.
- Design, implement, and manage controls related to claims obligations, including Medicare Secondary Payer, Section 111 reporting, OFAC, market conduct, and other federal protocols.
- Partner with claims technical, legal, IT, QA, SIU, licensing, and training teams to design compliant workflows and processes.
- Lead and support regulatory inquiries, complaints, audits, and market conduct examinations.
- Review large volumes of claim files and develop defensible responses to regulatory findings.
- Develop and execute compliance monitoring programs, audits, dashboards, and effectiveness reporting.
- Support claims system enhancements and compliance-related technology integrations.
- Participate in and lead training sessions and roundtables with claims handlers and leadership.
Skills & Experience
- 10+ years of experience in insurance claims compliance, insurance regulation, or legal/claims operations.
- Deep knowledge of claims handling regulations, market conduct standards, and federal claims requirements.
- Demonstrated experience operating in a true 50-state claims environment with jurisdictional variability.
- Strong understanding of Medicare lien processes and settlement requirements.
- Experience supporting regulatory audits, examinations, and enforcement actions.
- Ability to analyze claim files, assess compliance findings, and construct clear legal or regulatory arguments.
- Strong research, writing, analytical, and stakeholder communication skills.
- Proven ability to work independently, manage competing priorities, and perform under pressure
If interested, please apply to this job advert or reach out to [email protected]
