Job Description

Claims Compliance Analyst

Job Summary

Seeking a highly skilled and experienced Claims Compliance Analyst to join a growing team. This role is integral to ensuring compliance with claims regulations across all 50 states and federal jurisdictions. You will work closely with internal claims teams, legal departments, and third-party administrators to maintain best-in-class claims practices and regulatory compliance. 

Compensation Package

• Salary Range: $90,000 - $130,000 per year (based on experience)
• Benefits Include:
  • Competitive benefits package, 401(k), paid time off, professional development opportunities, etc.

Responsibilities

As a Claims Compliance Analyst, your key responsibilities will include:

• Maintaining a centralized 50-state claims compliance library.
• Assisting with internal audits and regulatory reviews.
• Ensuring adherence to claims best practices.
• Analyzing data and file trends to identify potential compliance issues and developing solutions.
• Providing compliance support to internal teams and external vendors.

Qualifications/Requirements

The ideal candidate will possess the following qualifications:

• A minimum of 10 years of experience in claims compliance, insurance regulation, or legal operations.
• A Juris Doctor (J.D.) degree is strongly preferred; advanced insurance compliance certification is a plus.
• Experience with multiple lines of business in a 50-state claims environment.
• Knowledge of Medicare Secondary Payer requirements and Section 111 reporting.
• Strong research and policy writing skills.
• Excellent collaboration, project management, and problem-solving abilities.

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