Team Lead - Claims Compliance
Team Lead - Claims Compliance
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Job Description
Job Description
Job Summary
The Team Lead Claims Compliance will oversee regulatory compliance activities across multiple property and casualty lines with a primary focus on workers compensation. This role requires a proactive individual with a solid understanding of the claims process and regulatory requirements. The ideal candidate will have experience in commercial lines insurance and leadership acumen ensuring compliance with state and federal regulations while managing a small team. This position involves working on multiple projects coordinating the implementation of regulatory changes and liaising with state regulatory authorities.
Responsibilities
- Lead efforts to review and assess changes in state laws regulations and statutes in collaboration with Legal/Compliance and Claims leaders.
- Coordinate the implementation of regulatory and statutory changes including updates to forms workflows and procedures to ensure compliance.
- Review and analyze claims data to identify trends risks and areas of noncompliance.
- Conduct or lead regulatory compliance audits evaluate findings and recommend process improvements.
- Oversee the implementation of Claims remediation plans ensuring timely and proper documentation.
- Serve as the main point of contact for Claims compliance matters managing RegEd notifications and maintaining a compliance notice repository.
- Lead Claims involvement in market conduct and other regulatory examinations across all lines of business.
- Ensure the Claims Best Practices Manual Authority Letters and user manuals are updated and stored appropriately.
- Coordinate training programs to ensure Claims teams have the required knowledge of regulatory changes.
- Monitor compliance with state and federal regulations including Medicare claims compliance to prevent fines and penalties.
- Collaborate with the Legal/Compliance team to develop action plans for resolution of fines or penalties.
- Lead efforts in responding to bureau criticisms Department of Insurance and other insurance complaints.
- Prepare summary reports and trend analysis for upper management on compliance strengths weaknesses and actionable improvements.
- Supervise a small team including interviewing hiring training performance evaluation and resolving employee concerns.
Qualifications/Requirements
- A strong working knowledge of Claims P&C regulatory requirements with expertise in workers compensation.
- Bachelors degree required; JD preferred.
- At least 4 years of experience in commercial lines insurance including workers compensation.
- Ability to assess processes identify risks and implement best practice resolution strategies.
- Ability to work independently and collaboratively with various teams.
- Strong analytical organizational critical thinking and project management skills.
- Excellent communication documentation and interpersonal skills.
- Ability to manage multiple projects and meet deadlines in a fastpaced environment.
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 employers discretion.
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Employment Type
Full-Time
