Claims Regulatory Compliance Manager

Amerisure Mutual Insurance•Farmington Hills, MI

4d•Hybrid

About The Position

Amerisure is seeking a Claims Regulatory Compliance Manager to ensure the Claims department adheres to all applicable laws, regulations, and industry standards. This role involves monitoring regulatory changes, implementing compliance policies, conducting internal audits, and liaising with regulatory authorities. The position offers a hybrid work arrangement with a 2-day onsite requirement in one of Amerisure's offices.

Requirements

5 years of commercial insurance experience.
2 years of leadership experience.
Proven experience in regulatory compliance within the insurance industry, with a focus on claims compliance.
Strong understanding of insurance laws, regulations, and industry best practices.
Intermediate proficiency with Microsoft Office Suite.
Ability to think strategically with supporting analytical and problem-solving skills, including the ability to deal with ambiguity.
Demonstrated successful ability to build positive relationships and partnerships within department and across the organization.
Excellent verbal and written communication skills with the ability to interact with internal and external customers.

Nice To Haves

Bachelor’s degree in business, law, or a related field preferred.
Advanced degrees or certifications in compliance preferred.
Ability to travel overnight up to 15%.

Responsibilities

Manage, train, provide performance feedback and assign duties of direct reports to ensure productivity, efficiency, and effectiveness.
Develop, review, and update internal claims processing policies and procedures to ensure compliance with regulatory standards.
Collaborate with other departments to integrate compliance considerations into company-wide policies.
Develop and implement strategic plans for area of responsibility.
Serve as the claims department’s main point of contact with regulatory bodies and coordinate the people and necessary information to respond to state audits and other regulatory inquiries.
Maintain accurate and comprehensive records as required by laws and regulations or company needs and ensure that information is readily available for review as necessary.
Design, implement, and monitor regulatory enterprise risk management solutions with input from other department leaders, Internal Audit, Office of Legal Counsel, and others as applicable.
Manage the department’s quality assurance process and provide analysis and updates based on findings and trends.
Prepare and submit regulatory reports, such as data calls, requests for information, internal controls testing etc., as required which may include coordinating with Financial Services, Internal Audit, Office of Legal Counsel, or external vendors as appropriate.
Develop, lead, and implement training programs for claims staff to enhance their understanding of Medicare compliance requirements, emphasizing accurate documentation and reporting.
Remain perpetually informed about changes to all relevant laws and regulations and, in a timely manner, update the department and/or specific stakeholders as to the impact of those changes, as appropriate.