Claims Compliance Strategy Specialist
About The Position
The Claims Compliance Strategy Specialist is an exempt position that reports to the Director, Claims Strategy. This role evaluates, advises on, and supports business adherence requirements across the claims organization to help ensure compliance with regulatory, reporting, and operational standards. The Claims Compliance Strategy Specialist monitors laws, regulations, and reporting requirements; assesses business and system impacts; partners with information technology and business stakeholders on project implementations; and identifies opportunities to improve processes, reduce risk, and strengthen compliance. This position serves as a resource on claims business adherence requirements and supports the successful implementation of regulatory, reporting, and operational changes across the organization.
Requirements
- Bachelor’s degree or appropriate combination of insurance industry claims designation(s).
- Minimum five years of commercial insurance experience, at least two of which in compliance or regulatory reporting.
- In depth knowledge of Medicare, insurance reporting bureaus, and state-specific laws and reporting requirements.
- Excellent regulatory, legal research and analytical skills.
- Excellent communication, interpersonal, and organizational skills.
- Ability to work at both strategic and technical levels.
- Strong background and experience in process improvement and data analysis.
- Ability to understand reporting requirements, system functionality and communicate required changes.
- Ability to work independently.
- Action and results-oriented, with ability to operate at both a strategic and operational level.
Responsibilities
- Monitor accuracy, acceptance, and changes related to regulatory agencies’ requirements.
- Monitor and analyze commercial claim laws and regulations that may affect WCF’s claims handling policies and practices.
- Research, identify and QA potential areas of risk for the claims department.
- Review, advise and participate in IT project implementation.
- Partner with IT to ensure systems and processes meet business adherence standards.
- Bring cross-functional teams together to prioritize, develop and implement necessary changes.
- Assist other internal departments with understanding and implementing requirements for business adherence.
- Assist with any regulatory audits, DOI and market conduct exams.
- Stay current on all commercial insurance claims law and regulation changes.
- Keep leadership informed of business-adherence related developments in a timely manner.
Benefits
- Medical, dental, and vision insurance.
- Company paid life insurance
- 401K with a generous 6% employer match
- Employee Assistance Program (EAP)
- Time off to volunteer in the local community
- All employees earn 4 weeks of vacation their first year.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
