Compliance Analyst

MSIG USA•Atlanta, GA

About The Position

The Claims Compliance Analyst supports the Claims Regulatory & Compliance function by monitoring, analyzing, and helping ensure adherence to federal and state claim-related regulatory requirements. The role analyzes compliance data and trends, supports workers’ compensation EDI and CMS reporting obligations, and assists with identifying and resolving compliance issues. It works closely with Claims, Operations, Information Technology, and external vendors to promote accurate and timely regulatory reporting. The position supports workers’ compensation EDI reporting, including FROI and SROI transactions; analyzes rejected transactions and claim data; supports NCCI and independent bureau IDC reporting; and researches jurisdiction-specific requirements and reporting deadlines. It also analyzes regulatory changes and their potential impact on claim systems, data, reporting, and operational processes; maintains documentation of reporting obligations; assists with regulatory requests and system testing; and maintains a listing of adjuster licenses. The analyst supports CMS Medicare Secondary Payer and Section 111 reporting, examines CMS data for accuracy and completeness, researches and helps resolve errors and discrepancies, and coordinates with stakeholders on reporting issues. The role also develops and maintains compliance reports and tracking tools, performs reconciliation and exception analysis, monitors issues and deadlines, and assists with root-cause analysis.

Requirements

Strong Microsoft Office skills, including Word, Excel, and PowerPoint.
Strong analytical, problem-solving, documentation, and written communication skills.

Nice To Haves

Bachelor’s degree in business, insurance, risk management, compliance, data analytics, or a related field, or equivalent relevant experience.
Experience in insurance claims, regulatory compliance, workers’ compensation, or regulatory reporting.
Exposure to Guidewire ClaimCenter.
Knowledge of workers’ compensation EDI/FROI/SROI reporting.
Knowledge of CMS Medicare Secondary Payer/Section 111 reporting.

Responsibilities

Support state workers’ compensation EDI reporting, including applicable FROI and SROI transactions.
Analyze rejected or failed transactions and assist in determining appropriate corrective action.
Analyze claim and transaction data to identify recurring rejection patterns, data-quality issues, and reporting exceptions.
Support NCCI and independent bureau IDC reporting.
Research jurisdiction-specific EDI requirements, implementation guides, event tables, edit matrices, and reporting deadlines.
Analyze regulatory changes and assess their potential impact on claim systems, data, reporting, and operational processes; translate requirements into clear business and data requirements.
Maintain documentation of applicable reporting requirements, deadlines, data elements, and compliance obligations.
Assist with regulatory inquiries, data requests, examinations, and other compliance-related requests.
Participate in testing system changes affecting CMS, EDI, or other regulatory reporting.
Maintain a listing of adjuster licenses.
Support compliance with applicable CMS Medicare Secondary Payer reporting requirements, including Section 111 reporting for applicable claims.
Analyze CMS reporting data for completeness, accuracy, consistency, and potential reporting exceptions.
Research and assist in resolving CMS reporting errors, rejected records, data discrepancies, and other reporting issues.
Coordinate with Claims, IT, vendors, and other stakeholders to resolve CMS data and reporting issues.
Develop and maintain compliance reports, dashboards, spreadsheets, and tracking tools.
Perform reconciliation and exception analysis of regulatory reporting data.
Analyze reporting results to identify trends, anomalies, recurring errors, and potential process gaps.
Monitor outstanding compliance issues, corrective actions, regulatory deadlines, and remediation activities.
Assist with root-cause analysis of regulatory reporting issues.