Compliance Analyst - P&C

MSIG Holdings•Cincinnati, OH

1d•$80,000 - $100,000

About The Position

The Claims Compliance Analyst supports MSIG USA’s 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 helps identify and resolve compliance issues. It works closely with Claims, Operations, Information Technology, and external vendors to promote accurate and timely regulatory reporting. The position supports state workers’ compensation EDI reporting, including applicable FROI and SROI transactions, as well as NCCI and independent bureau IDC reporting. It analyzes rejected or failed transactions and reporting data, researches jurisdiction-specific requirements and deadlines, and supports regulatory compliance analysis and CMS Medicare Secondary Payer reporting. The analyst also develops and maintains compliance reports and tracking tools, monitors corrective actions and deadlines, and assists with root-cause analysis.

Requirements

Bachelor’s degree in business, insurance, risk management, compliance, data analytics, or a related field, or equivalent relevant experience.
Experience in property and casualty insurance claims, regulatory compliance, workers’ compensation, or regulatory reporting.
Knowledge of workers’ compensation EDI/FROI/SROI reporting.
Strong Microsoft Office skills, including Word, Excel, and PowerPoint.
Strong analytical, problem-solving, documentation, and written communication skills.

Nice To Haves

Exposure to Guidewire ClaimCenter.
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 help determine 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 regulatory 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.