Claims Compliance & Technology Director

EMC Insurance; United States; Remote; USD 109,000 - 158,000; Full time

Job summary

An established industry player is seeking a dynamic leader to oversee claims compliance and training efforts. This role involves guiding a dedicated team, implementing best practices, and ensuring compliance across various lines of business. You will have the opportunity to foster a collaborative environment, manage resources, and contribute to the overall success of the organization. With a focus on innovation and continuous improvement, this position offers a chance to make a significant impact while working from the comfort of your home anywhere in the United States. If you are passionate about leading teams and driving results, this is the perfect opportunity for you.

Qualifications

• Bachelor’s degree or equivalent experience in relevant field.
• Ten years of claims experience including adjusting and compliance.

Responsibilities

• Lead claims compliance and oversee training activities.
• Monitor KPIs and ensure workflow processes are efficient.

Skills

Insurance policies knowledge

Claims procedures understanding

Research and analytics skills

Problem-solving skills

Leadership skills

Communication skills

Organizational skills

Workforce management

Education

Bachelor’s degree in insurance, finance, accounting, or business administration

Ten years in claims experience

Insurance certifications (CPCU, INS, AIC)

Tools

Guidewire

Microsoft Office Suite

Job description

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.

This position is eligible to work from home anywhere in the United States.

Essential Functions:

1. Lead the claims compliance and Medicare compliance team across all lines of business and programs.
2. Provide oversight, guidance, and assistance to the team.
3. Create, track, and monitor KPIs and develop a business plan for areas of oversight.
4. Export metric reports to monitor trends, track team functions, and implement standards to ensure workflow processes are followed efficiently.
5. Monitor work products for completeness, accuracy, and timeliness; identify trends and recommend improvements.
6. Implement strategic direction and ensure the success of the claims training team across all lines of business and programs.
7. Lead prioritization and decision-making related to training activities, ensuring effective communication and organizational goals are met within resource constraints.
8. Ensure completion of testing and training by relevant teams, including technical staff, to validate updates and improvements.
9. Establish and enhance department-level best practices to ensure efficiency and consistency, providing feedback and communicating necessary changes.
10. Oversee onboarding materials for new hires to facilitate their success.
11. Lead the claims information team and oversee Guidewire transition and claims innovation efforts, ensuring compliance and system functionality.
12. Collaborate with leadership, stakeholders, and subject matter experts to meet goals and improve user experience.
13. Serve as the Guidewire SME, ensuring system updates are correctly implemented.
14. Lead pre- and post-implementation activities and guide internal communications regarding claims procedures and forms.
15. Build team culture, develop team members, set performance goals, conduct reviews, and support diversity and inclusion initiatives.
16. Foster an innovative and collaborative environment with IT, Underwriting, and other stakeholders.
17. Manage budget resources, forecast expenditures, and utilize Adaptive for tracking expenses.
18. Coordinate with claims teams across all lines of business to ensure efficiency and continuity, providing recommendations for improvements.
19. Participate in corporate claims projects, conduct research and testing, and report project status to leadership.

Education & Experience:

• Bachelor’s degree in insurance, finance, accounting, business administration, or related field, or equivalent experience.
• Ten years in claims, including claims adjusting and compliance.
• Prior training experience preferred.
• Insurance certifications such as CPCU, INS, or AIC preferred.
• Guidewire experience preferred.

Knowledge, Skills & Abilities:

• Strong knowledge of insurance policies, claims philosophy, procedures, and terminology across all lines of business.
• Excellent understanding of insurance contracts and claims data reporting.
• Research, analytics, investigation, and problem-solving skills.
• Knowledge of medical terminology is a plus.
• Proficiency in Microsoft Office Suite and claims systems.
• Workforce management, communication, organizational, and leadership skills.
• Ability to manage multiple priorities and adapt to changing deadlines.
• Occasional travel with a valid driver’s license.

The salary range varies by location, with the following ranges: $109,818-$157,391 or $121,061-$173,534. Actual compensation depends on education, skills, experience, and location.

Our employment practices comply with applicable laws prohibiting discrimination based on race, color, creed, sex, sexual orientation, gender identity, and other protected categories.

All locations are tobacco-free, including in company vehicles.