Remote Senior Claims Oversight & Governance Analyst

Logoslabs; San Francisco (CA); Teletrabalho; USD 74 000 - 93 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Competitive pay

Fully remote

Healthcare coverage

HSA/FSA

Parental leave

Retirement plan

PTO + holidays

Wellness day

Volunteer time off

EAP access

Resumo da oferta

Logoslabs seeks a Carrier Senior Claims Oversight Analyst based in the United States. This role strengthens claims governance, ensures regulatory compliance, and improves operational performance across delegated claims operations.

It blends advanced claims analysis with risk management to support accurate decisions. You will collaborate with TPAs and internal teams to review complex claims, resolve escalations, and implement corrective action plans.

Qualificações

• Extensive experience in claims governance and regulatory compliance.
• Ability to assess complex claims and provide clear recommendations.
• Experience overseeing audits, QA, and third-party administrators.
• Strong communication and stakeholder management skills.

Responsabilidades

• Review high-value, complex, and escalated claims with recommendations.
• Evaluate coverage determinations and ensure policy-based decisions.
• Oversee TPAs to ensure contractual and regulatory compliance.
• Identify trends, risks, and opportunities to improve quality.
• Support audits, regulatory inquiries, and corrective actions.
• Assist with fraud investigations and risk mitigation.
• Analyze claims data and performance metrics for improvements.
• Develop and update handling guidelines and procedures.
• Communicate policy changes and operational expectations clearly.
• Provide training and coaching to colleagues on claims practices.

Conhecimentos

Claims governance

Regulatory compliance

Data analysis

Risk management

Stakeholder collaboration

Audit & QA

Formação académica

Bachelor's degree in Business or Insurance

Descrição da oferta de emprego

Logoslabs seeks a Carrier Senior Claims Oversight Analyst based in the United States. This role strengthens claims governance, ensures regulatory compliance, and improves operational performance across delegated claims operations.

It blends advanced claims analysis with risk management to support accurate decisions. You will collaborate with TPAs and internal teams to review complex claims, resolve escalations, and implement corrective action plans.