Job Description

Senior Claims Compliance Analyst

Our client is seeking a Senior Claims Compliance Analyst to join their growing team. This high-impact role is responsible for helping mitigate regulatory risk and ensuring compliance across claims operations. The ideal candidate will be an experienced insurance claims compliance professional or attorney with a strong understanding of claims regulations, processes, and technology. Success in this position requires the ability to assess complex regulatory requirements, translate risk into practical business solutions, and develop sustainable compliance frameworks that support organizational objectives.

Key Responsibilities:

• Manage and maintain 50-state claims database
• Monitor legislation, DOI bulletins, court reporters/decisions, and statutory changes; manage backlog and implement targeted compliance training
• Develop and own controls related to Medicare, OFAC, Child Support Lien Network, and other federal protocols
• Partner with Claims Technical, US Legal, and IT to design controls and workflows aligned with regulatory requirements
• Lead US Claims response to regulatory inquiries and complaints
• Deliver training and legal support to internal teams and vendors
• Develop audit programs and dashboards to monitor compliance effectiveness
• Oversee/support technology-related compliance integrations
• Provide executive reporting, trends analysis, and regulatory insights

Qualifications:

• 10+ years of experience in claims compliance, insurance regulation, or legal operations
• J.D. highly desired
• Degree in law, risk management, or a related field; required
• Advanced insurance compliance certifications a plus (CPCU, CIPP, CAMS, CRCM, or similar) Scrum/PMP a plus but not required
• Deep understanding of claims handling regulations, Medicare protocols, and market conduct standards
• 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 skills
• Experience with regulatory audit preparation and response

Compensation: $90,000–$150,000 based on experience

• 401(k) with competitive company matching  
• Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)   
• Company paid group term life, short- term disability and long-term disability coverage  
• 26 Paid time off days, 10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days  
• Paid parental leave  

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