Claims Manager, Regulatory Compliance
Our client, a specialized captive insurance organization, is seeking an experienced Claims Manager, Regulatory Compliance to oversee claims management activities while supporting regulatory and compliance requirements across the organization.
The primary focus of this role is claims management and administration. The ideal candidate will come from a traditional insurance carrier, MGA, or TPA environment and have a thorough understanding of the claims lifecycle, insurance policies, coverage, documentation, and claims processes. Experience with captive insurance is a plus, but not required.
This is a hands-on role for an insurance professional who is highly detail-oriented, technically proficient, and an excellent communicator. The Claims Manager will work closely with the Accounting team, policyholders, TPAs, regulators, and other internal and external stakeholders.
The regulatory compliance component of the role primarily involves maintaining relationships and communicating with state insurance regulators and state departments. A strong claims professional with the right communication and relationship-building skills can be successful in this area, as the regulatory component can be learned.
Responsibilities
Claims Management
- Manage and oversee the claims process from initial notice through resolution.
- Receive, document, track, and monitor claims to ensure timely and accurate handling.
- Review claims for completeness, accuracy, and compliance with applicable policy terms and procedures.
- Develop a thorough understanding of policy language and identify potential coverage issues or concerns.
- Coordinate claims investigations and ensure appropriate documentation and information is collected.
- Work closely with policyholders, adjusters, attorneys, TPAs, vendors, and other parties involved in the claims process.
- Manage claims handled internally and coordinate the transition of larger or more complex claims to external TPAs.
- Monitor claim activity, outstanding items, deadlines, reserves, settlements, and payments.
- Maintain complete, accurate, and well-organized claim files and documentation.
- Assist with claim evaluations, reserve updates, settlements, and payment processing as appropriate.
- Escalate complex, disputed, or significant claims to the appropriate internal or external resources.
- Prepare claims reports, summaries, and updates for management and internal stakeholders.
- Work closely with the Accounting team regarding claims, reserves, payments, and related financial information.
- Identify opportunities to improve claims processes, procedures, documentation, and overall efficiency.
- Ensure claims are managed consistently with policy terms, established procedures, and applicable regulatory requirements.
Regulatory Compliance
- Support regulatory compliance activities for captive insurance companies.
- Communicate and maintain strong working relationships with state insurance regulators and state departments.
- Respond to regulatory inquiries and coordinate information requested by regulators.
- Assist with required regulatory submissions, filings, and documentation.
- Support compliance with applicable insurance laws, regulations, internal policies, and procedures.
- Monitor regulatory requirements and assist with implementing necessary changes.
- Maintain accurate and organized regulatory records and documentation.
- Support regulatory examinations, audits, and other compliance-related reviews.
- Coordinate with internal teams, clients, actuaries, accountants, attorneys, and other professional partners as needed.
- Build and maintain positive relationships with regulators and other key stakeholders.
Policy & Documentation
- Prepare, update, and maintain insurance policies and related documentation.
- Assist with policy changes, endorsements, and other policy-related updates.
- Make policy changes and accurately redline policy language and documents using Microsoft Word.
- Review policy and claims documentation for accuracy, completeness, and consistency.
- Prepare and issue insurance policies and reinsurance contracts as needed.
- Maintain organized and accurate records of policy changes and related documentation.
Qualifications/Requirements
- Bachelor’s degree in insurance, business, finance, risk management, or a related field preferred.
- Strong Claims Management experience within a traditional insurance carrier, MGA, TPA, or similar insurance environment.
- Thorough understanding of the claims lifecycle and claims management process.
- Experience with P&C and/or Excess & Umbrella insurance strongly preferred.
- Captive insurance experience is a plus, but not required.
- Experience working with insurance policies and understanding policy language, coverage, and policy changes.
- Ability to make policy changes and confidently redline policy documents in Microsoft Word.
- Strong understanding of insurance terminology and processes.
- Excellent attention to detail and strong organizational skills.
- Exceptional written and verbal communication skills.
- Strong interpersonal and relationship-building skills, particularly when working with regulators, clients, and external partners.
- Strong technical proficiency and comfort working with Microsoft Office and insurance-related systems.
- Ability to manage multiple claims, deadlines, and priorities in a fast-paced environment.
- Strong judgment, problem-solving, and decision-making skills.
- Ability to work independently, take ownership of responsibilities, and follow through on commitments.
- Professional insurance designation such as CPCU or similar is a plus.
Compensation Package
Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.
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