Claims Compliance Analyst – Workers' Compensation

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee and ensure adherence to workers' compensation laws, regulations, and internal policies.

• Examine and evaluate claim submissions from insurance providers and self-insured organizations for prompt and precise entries.

• Detect and resolve discrepancies or compliance issues, including initiating corrective measures or penalties.

• Collaborate with IT or vendor teams to enhance systems related to compliance monitoring.

• Offer insights into system requirements for platforms handling workers' compensation claims.

• Assist in audit and compliance training initiatives.

• Keep abreast of updates in workers’ compensation laws and regulations.

• Design and present training and educational resources focused on claims compliance for claims personnel.

• Organize and lead state-specific regulatory training sessions with both internal and external stakeholders.

• Review and verify the data elements, forms, notices, and calculations within workers' compensation claims systems and workflows to ensure current compliance.

⛳️ Requirements

• Comprehensive understanding of workers’ compensation.

• A bachelor's degree is mandatory.

• Capability to evaluate processes, pinpoint critical risk areas, and apply resolution strategies aligned with best practices.

• Proficiency in engaging with various levels of staff and state regulatory bodies.

• Ability to work autonomously as well as collaboratively.

• Adaptability to manage multiple projects and adhere to tight deadlines.

• Strong skills in analysis, research, organization, critical thinking, and project management.

• Excellent communication and documentation abilities.

• A minimum of 4 years’ experience in commercial insurance claims, particularly in workers' compensation.

• Preferred experience in auditing, regulatory compliance, or compliance monitoring within the workers' compensation or insurance sectors.

🏝️ Benefits

• Medical (PPO/HDHP), vision, disability, and life insurance.

• Enhanced dental plan that includes orthodontia coverage alongside a standard plan.

• Generous paid time off (PTO) plan for all eligible employees.

• Paid company holidays and 4 additional floating holidays.

• Paid parental leave.

• Employee Retirement Savings Plan/401(k) with company matching and immediate vesting.

• Education Assistance Program providing 100% upfront tuition reimbursement after 6 months of service for approved degree programs.

• Service Recognition Program offering a monetary award toward a vacation every 5 years of employment.

• Wellness Initiatives, including Fitness Center and Weight Watchers Reimbursement programs.

• Optional accident, critical illness, and hospital indemnity benefits.

• Employee discount and rewards program for travel, tickets, electronics, home goods, and more.