Sr. Claims Compliance Analyst

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Position Summary:

The Senior Claims Analyst will report directly the Vice President of Claims Compliance. Senior Claims Compliance Analyst will coordinate with the claims organization, including Third Party Administrators (TPAs). In this capacity, the Senior Claims Compliance Analyst is responsible for Regulatory Compliance and Reporting, Coordinating State Audits and Inquiries and Claim Operational Controls. This role should proactively identify gaps and opportunity areas to ensure Claims Compliance. The Senior Claims Compliance Analyst will have Global Services support and will be instrumental in building the Claims Compliance function.

Responsibilities:

Regulatory Compliance and Reporting

• Monitor and identify relevant regulatory changes and determine potential impact to the claims organization
• Communicate regularly changes to appropriate business units
• Identify any required system or process changes ensure regulatory compliance and reporting
• Gather data to prepare and analyze Compliance managed regulatory reports and data calls. Timely submit state specific annual/quarterly reports where required.
  
  

State Inquiry and Audit Coordination

• Coordinate effective responses to any inquiries by the State Departments of insurance. Will serve as an intermediary between the business, handling entity, and the State Departments.
• Coordinate Claims Audits that are conducted by the various State Departments.
• Medicare Reporting and Lien Management experience
• Analyze and assess audit reports and complaints that are issued by the State Departments to identify performance issues.
• Review state report cards and metrics on claims processing and reporting and work with TPAs and Arch staff to remediate any issues.
• Fostering working relationships with regulatory bodies and Arch business groups supporting Compliance efforts.
  
  

Claim Operational Controls

• Monitor claims operational control structure and recommend any necessary changes to controls based upon audit feedback
• Drive continuous improvement and development of claim control library/documentation
• Support all internal audit processes
• Assist with both the development of enterprise-wide Compliance best practices and delivery of compliance training
• Conduct periodic compliance quality reviews for both internal claim departments and TPAs
  
  

Experience and Required Skills:

• Knowledge of state insurance regulations
• Knowledge of Medicare compliance is a plus
• Efficient organization and project management skills
• Familiarity with Wolters Kluwer, Lexis/Nexis or similar subscription services
• Proficiency with the suite of Microsoft products such as Excel, Word, PowerPoint, etc.
• Ability to effectively communicate ideas, issues and solutions.
  
  

Education:

• Must have at least 5-7 years’ Claims Compliance experience.
• P&C claims knowledge, and the ability to communicate effectively with external business partners. Working knowledge of SOX controls and testing is preferred.
  
  

For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible.

$85,295 - $148,902/year

• Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future.
• Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits.
  
  

Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn’t the right fit but you’re interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch’s Talent Acquisition team.

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