Remote Claims Compliance & Strategy Specialist

Wcf-Insurance; Wallace Heights (UT); Ibrido; USD 98.000 - 122.000; Tempo pieno

Descrizione del lavoro

WCF Insurance seeks a Claims Compliance Strategy Specialist to evaluate, advise, and support regulatory adherence across the claims organization. This exempt role partners with IT and business stakeholders on project implementations to strengthen compliance and reduce risk.

Requirements include a Bachelor’s degree and at least five years in commercial insurance, with a focus on compliance or regulatory reporting, Medicare knowledge, and strong analytical skills.

Competenze

• Bachelor’s degree or appropriate combination of insurance industry claims designation(s).
• Minimum five years of commercial insurance experience, at least two 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.
• Strong communication, interpersonal, and organizational skills.
• Ability to work at both strategic and technical levels.
• Experience in process improvement and data analysis.
• Ability to understand reporting requirements, system functionality, and communicate required changes.
• Ability to work independently.

Mansioni

• 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 regulatory audits, DOI and market conduct exams.

Conoscenze

Regulatory compliance

Data analysis

Communication

Regulatory research

Process improvement

Project coordination

Formazione

Bachelor's degree

Strumenti

Regulatory reporting software

Descrizione del lavoro

WCF Insurance seeks a Claims Compliance Strategy Specialist to evaluate, advise, and support regulatory adherence across the claims organization. This exempt role partners with IT and business stakeholders on project implementations to strengthen compliance and reduce risk.

Requirements include a Bachelor’s degree and at least five years in commercial insurance, with a focus on compliance or regulatory reporting, Medicare knowledge, and strong analytical skills.