Claims Compliance Strategy Specialist

WCF Insurance; Sandy (UT); Remote; USD 98,000 - 122,000; Full time

Job summary

WCF Insurance in Sandy, UT is seeking a Claims Compliance Strategy Specialist. This exempt role reports to the Director, Claims Strategy and evaluates, advises on, and supports adherence to regulatory, reporting, and operational standards across the claims organization.

The position collaborates with IT, analyzes laws and reporting requirements, and helps implement changes. Open to on-site, remote, or travel to Sandy for team events; remote staff may travel as needed.

Qualifications

• Bachelor’s degree or insurance designation(s) required.
• Minimum five years of commercial insurance claims experience.
• At least two years in compliance or regulatory reporting.
• Knowledge of Medicare, reporting bureaus, and state laws.
• Strong regulatory research and analytical skills.
• Excellent communication and organizational skills.
• Ability to work independently.

Responsibilities

• Monitor regulatory requirements across agencies.
• Analyze commercial claim laws affecting policies.
• QA potential risk areas for claims department.
• Review and advise IT project implementations.
• Partner with IT to ensure compliant systems.
• Coordinate cross-functional teams to implement changes.
• Assist departments with adherence requirements.
• Support regulatory audits and market conduct exams.

Skills

Regulatory knowledge

Analytical skills

Communication skills

Independence

Project coordination

Data analysis

Education

Bachelor’s degree or insurance designation(s)

Job description

WCF Insurance is an “A” rated, innovative property and casualty carrier with more than a century of experience serving businesses across the Western United States. Since 1917, we have built our reputation on doing the right thing, being great at what we do, and helping others succeed. As we continue to grow, we are looking for individuals who share these values and want to contribute to delivering an excellent insurance experience.

Position Overview

The Claims Compliance Strategy Specialist is an exempt position that reports to the Director, Claims Strategy. This role evaluates, advises on, and supports business adherence requirements across the claims organization to help ensure compliance with regulatory, reporting, and operational standards. The Claims Compliance Strategy Specialist monitors laws, regulations, and reporting requirements; assesses business and system impacts; partners with information technology and business stakeholders on project implementations; and identifies opportunities to improve processes, reduce risk, and strengthen compliance. This position serves as a resource on claims business adherence requirements and supports the successful implementation of regulatory, reporting, and operational changes across the organization.

Open to individuals within range of our offices located in Sandy, UT; Las Vegas, NV; Englewood, CO; Meridian, ID; Sacramento, CA; or fully remote for those outside of reasonable commuting distance. Please note that remote employees may be expected to travel to our Sandy, Utah headquarters for team collaboration events.

Qualifications

• Bachelor’s degree or appropriate combination of insurance industry claims designation(s).
• Minimum five years of commercial insurance experience, at least two of which in compliance or regulatory reporting.
• In depth knowledge of Medicare, insurance reporting bureaus, and state-specific laws and reporting requirements.
• Excellent regulatory, legal research and analytical skills.
• Excellent communication, interpersonal, and organizational skills.
• Ability to work at both strategic and technical levels.
• Strong background and experience in process improvement and data analysis.
• Ability to understand reporting requirements, system functionality and communicate required changes.
• Ability to work independently.

Essential Job Functions

• Monitor accuracy, acceptance, and changes related to regulatory agencies’ requirements.
• Monitor and analyze commercial claim laws and regulations that may affect WCF’s claims handling policies and practices.
• Research, identify and QA potential areas of risk for the claims department.
• Review, advise and participate in IT project implementation.
• Partner with IT to ensure systems and processes meet business adherence standards.
• Bring cross-functional teams together to prioritize, develop and implement necessary changes.
• Assist other internal departments with understanding and implementing requirements for business adherence.
• Assist with any regulatory audits, DOI and market conduct exams.

Accountability & Requirements

• Stay current on all commercial insurance claims law and regulation changes.
• Action and results-oriented, with ability to operate at both a strategic and operational level.
• Keep leadership informed of business-adherence related developments in a timely manner.

WCF Insurance offers an extensive compensation package. Benefits include:

• Medical, dental, and vision insurance.
• 401K with a generous 6% employer match
• Employee Assistance Program (EAP)
• Time off to volunteer in the local community
• All employees earn 4 weeks of vacation their first year.

The expected salary range for this position is $98,000.00 to $122,400.00. This salary range depends on experience, education, and location for this specific position.

Values

The person in this position must demonstrate the WCF values of doing the right thing, being great at your job, and helping others succeed to fulfill the company’s mission of excellence.

Working Conditions

This position is based in an office environment with adequate temperature and lighting control. There are no known hazardous or unpleasant conditions caused by noise, dust, or other environmental factors. There are potentially high-stress situations that require meeting deadlines. The employee must meet the job attendance requirements for this position.

Our People

WCF strives to provide an excellent work experience and cultivate an inclusive environment where anyone who embodies our values will thrive.

WCF Insurance is an Equal Opportunity Employer

WCF Insurance provides equal employment opportunity to all qualified applicants and employees regardless of race, color, religion, sex, age, national origin, veteran status, disability that can be reasonably accommodated, or any other basis prohibited by federal, state, or local law.