Business System Analyst

CWA Recruiting; New York (NY); Hybrid; USD 100,000 - 150,000; Full time

Job summary

CWA Recruiting in Nassau County, NY is seeking a seasoned Risk and Compliance Analyst to lead audits of claims processing for property and casualty operations.

You will collaborate with department leaders to ensure adherence to regulations and SOPs, develop dashboards and KPIs, and guide system improvements with IT and vendors.

Qualifications

• Five to seven or more years of advancing experience in property and casualty (P&C) insurance.
• Familiarity with operating structures and compliance for entering new jurisdictions.
• Ability to identify root causes of errors and suggest improvements.
• Experience collaborating with IT teams and external vendors.

Responsibilities

• Collaborate with leaders to ensure operations comply with regs and industry standards.
• Supervise pre- and post-payment adjudication audits for claims accuracy.
• Ensure adjudication aligns with SOPs and regulations.
• Investigate causes of errors to prevent recurrence.
• Review policies and SOPs for relevance and compliance.
• Suggest policy/SOP updates based on audit findings.
• Support expansion into new states and KPI development.
• Assist with month-end closings and data analysis.
• Engage in system development and vendor management.

Skills

Analytical thinking

Communication

Organization

Critical thinking

Data analysis

Education

Bachelor's degree in Business, Finance, Computer Science, Statistics or related discipline

Tools

SAP

Power BI

SQL

Python

R

Tableau

Excel

Job description

Nassau County, New York - Hybrid after 90 days / 3 days in office / 2 days remote

Responsibilities:

Collaborate with various departmental and team leaders to guarantee that all elements of operations adhere to applicable regulatory standards and industry best practices. In the planning team, you will engage with different departmental and team leaders to confirm that all facets of our operations comply with relevant regulations and industry benchmarks. Supervise and execute pre- and post-payment adjudication audits concerning claims to verify financial, processing, and operational accuracy. Ensure that claim adjudication is consistent with policy terms, standard operating procedures (SOPs), and applicable state or federal regulations. Investigate the primary reasons for errors, overpayments, or underpayments to avert their recurrence in the future. Review existing policies, SOPs, and guidelines to ascertain their relevance, accuracy, and compliance with contemporary laws and industry norms. Actively suggest updates to policies, SOPs, and guidelines based on audit insights and evolving legal obligations. Manage the operational setup and compliance frameworks necessary for business expansion into new states. Evaluate departmental workflows and results relating to claims to support the establishment of key performance indicators (KPIs) and evaluation metrics. Assist with month-end closings and deliver statistical data analysis. Engage in, and potentially oversee, system development, maintenance, and support, while collaborating with and managing external vendors.

Requirements:

Five to seven or more years of advancing experience in property and casualty (P&C) insurance, along with a solid comprehension of claims systems and extensive industry insight. Familiarity with the operational structure and compliance necessary for entering new jurisdictions is essential. Ability to independently identify the fundamental causes of mistakes and suggest strategic enhancements for quality improvement is required. Expertise in analyzing financial data is also necessary. Previous experience working in partnership with IT teams and outside vendors regarding system development, maintenance, or process enhancements is valuable. Strong skills in written and verbal communication, organization, critical thinking, and analysis are imperative. A bachelor's degree in Business, Finance, Computer Science, Statistics, or a related discipline is preferred. Familiarity with SAP, Power BI, SQL, Python, R, Tableau, Excel, and/or data cleaning is desired. Professional insurance designations such as CPCU or AIC are highly beneficial. Capability to create dashboards is expected.