Claim Compliance Director
Claim Compliance Director
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
ChubbNorth America Claims seeks a Claim Compliance Director to assist with and manage the day-to-day operations of the Chubb Quality Assurance and Compliance Programs associated with Workers Compensation Direct and Third-Party Administrators (TPAs) Accident & Health and Personal Injury Protection (PIP) claims.
RESPONSIBILITIES
- Assists with NA Claims market conduct examinations audits data calls and other state and federal inquiries inclusive of the preparation of management and remediation action plans associated with Workers Compensation A&H and PIP.
- Assist with and develop audit/compliance related responses to ad hoc audit requests and inquiries from various State regulators. Ability to assess dissect and craft a response to each matter independently for each State is a key responsibility of this role.
- Assists with various state and federal surveys investigations assessments and evaluations related to workers compensation LSHWA and DBA. Experience with EDI reporting strongly preferred as well as analyzing data sets to identify root cause trends.
- Work with North American Claims QA and Compliance Manager to ensure compliance in developing areas of insurance laws and regulations. Assist with focused audits from regulators and resulting Management Action Plans as required by the State. Provide recommendations and strategies for resolutions.
- Conduct independent regulatory research in conjunction with legal resources North American Claims QA & Compliance Manager and others based on evolving regulatory landscapes.
- Monitor regulatory changes that may impact the various lines of business and insurance programs. Identify gaps weaknesses and deficiencies and create ongoing improvements in claim compliance.
- Serve as a valued resource for Claims Operations Claims IT and Claim Optimization on critical workers compensation A&H and PIP claims regulatory and technical issues to ensure effective and efficient claim handling processes.
- Complete focused niche reviews based on jurisdictional compliance needs in areas of paramount importance for Chubb. Will closely collaborate with the Chubb NA Quality Assurance team on targeted and focused reviews.
- Monitor TPA action plans against ongoing results and re-evaluation as needed
Qualifications
- 10 or more years of insurance industry experience across multiple lines of insurance with specific experience in the area of workers compensation regulatory and claims compliance A&HPIP claims administration and operations.
- Broad based knowledge of jurisdictional insurance regulations and privacy laws with extensive experience with federal and state regulatory schemes.
- Strong analytical and technical skills to understand root causes of claims compliance deficiencies and respond effectively and efficiently with necessary short and long-term solutions recommendations and controls.
- Experience with quality assurance data collection and reporting software. Skilled use of Microsoft Office products (Excel PowerPoint Word Outlook Teams).
- Ability to manage multiple projects and consistently execute and deliver in a dynamic and developing environment. Strong ability to prioritize and consistently deliver results.
- Strong interpersonal skills ability to communicate and manage at all levels of the organization. Able to work independently as well as in groups.
- Travel required (15%).
Required Experience:
Director
Employment Type
Full-Time
