Claims Compliance Senior Representative

The Claims Compliance Senior Representative, working under minimal supervision, is responsible for wide-ranging duties within the Claims Compliance Department. The role works within a wide range of restrictions and authority on coordination and claim assignments with a higher level of technical difficulty. The role gathers requirements, organizes, and analyzes data, and researches and prepares for adjuster licensing, claim handling compliance reviews, regulatory reporting, reinsured obligations and/or state fair claims practices. The role assists with development and management of compliance processes and guidelines. The role also act as subject matter experts (SME) for internal business partners regarding adjuster licensing, complaint process, regulatory reporting, reinsurance, etc. and guide junior level compliance representatives.

#LI-DNI

• Coordinates development and maintenance of claims handling complaint processes, ongoing process improvement, and related tools.
• Maintains process for identifying, submitting, and monitoring regulatory reporting obligations related to Claims and continuously monitors statutory and regulatory updates that impact Claim Department obligations.
• Researches and gathers requirements, organizes, and analyzes data, identifies, and secures appropriate files, coordinates resources, reviews files to assure adherence to claim handling requirements, and identifies trends and opportunities.
• Develops and maintains a thorough working knowledge of state licensing requirements, regulatory and reinsurance reporting, and other statutory reporting requirements for company compliance.
• Maintains effective and ongoing communication with claim department leaders and staff, internal and external business partners, project team members, and vendors.
• Collaborates with team and other internal business partners seeking and/or aiding or input regarding adjuster licensing, regulatory reporting, complaint process, reinsurance, etc.
• Provides day-to-day, claim-specific support to the professionals on Compliance and identifies, analyzes, and corrects reporting errors including defects/trends.
• Performs ad-hoc individual claim file reviews as needed to assist claims professionals with issues related to compliance and participates in various internal/external compliance audits.
• Maintains effective and ongoing communication with claims department staff, internal and external business partners, insureds, claimants, agents, attorneys, other insurance companies, project team members, and vendors.
• Participates in process improvement initiatives to streamline claims processing operations, improve efficiency, and reduce compliance-related risks, and prepares requests for documentation and authorizations.

• 3-5 years of experience in Claims Compliance or a related field.
• Bachelor's degree in Business Administration or a related field and/or commensurate work experience.

Behavioral Competencies

• Collaborates
• Communicates effectively
• Customer focus
• Decision quality
• Nimble learning