Claims Compliance Analyst (Hybrid/Remote)

Selective Insurance
paid time off, tuition assistance
United States, New Jersey, Branchville
40 Wantage Avenue (Show on map)
Dec 18, 2024
About Us At Selective, we don't just insure uniquely, we employ uniqueness. Selective is a midsized U.S. domestic property and casualty insurance company with a history of strong, consistent financial performance for nearly 100 years. Selective's unique position as both a leading insurance group and an employer of choice is recognized in a wide variety of awards and honors, including listing in Forbes Best Midsize Employers in 2024 and certification as a Great Place to Work in 2024 for the fifth consecutive year. Employees are empowered and encouraged to Be Uniquely You by being their true, unique selves and contributing their diverse talents, experiences, and perspectives to our shared success. Together, we are a high-performing team working to serve our customers responsibly by helping to mitigate loss, keep them safe, and restore their lives and businesses after an insured loss occurs. Overview Review, track, and proactively manage compliance programs between Selective Insurance Company of America and regulatory agencies. Provide technical analysis and investigation of claim compliance functions, including but not limited to: data reporting to regulatory agencies, OFAC for claims and underwriting, Medicaid/Medicare data coordination and integrity, monitoring regulatory alert activity, and adjuster licensing compliance. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements. Responsibilities Review incoming regulatory alerts and coordinate communication with impacted staff. Assist in the identification of training and/or system needs in support of upcoming regulatory activity. Work in collaboration with claim staff, vendors, and IT partners to develop requirements, IT testing, as well as implementation. Alerts include but are not limited to: Data reporting, OFAC, Medicare, Medicaid, Child Support, and Adjuster Licensing. Plan, create, analyze, and implement electronic data interchange (EDI) systems and supporting processes. Position ensures these systems are working properly to enable the efficient exchange of information between regulatory agencies or among internal units within an organization.. Position will include testing, maintenance and troubleshooting, and may provide tech support. Examples include Unit Statistical Reporting, Indemnity Data Call, Medical Data call. Screen and process OFAC alert activity on a daily basis, within established time frames. Complete appropriate due diligence, document findings, and immediately escalate match activity which cannot be cleared. Act as liaison between Corporate Compliance, Selective claims, underwriting and SBU staffs, with regard to OFAC matters, responding immediately to expedite requests from the field. Serve as a Subject Matter Expert (SME) in coordinating Medicaid/Medicare reporting, including but not limited to issues with regard to data integrity and reporting. Assist claim handlers with Conditional Payment inquires and assist with Medicare and Medicaid lien resolution. Work with senior team members, legal and compliance to monitor all claim adjuster licensing related to our adjusters to ensure compliance with all state and federal regulations. Creates other compliance reports to send to claim handlers and management team to ensure compliance with regulatory requirements. Documents processes and procedures using flow charts and written documentation. Must be able to drive an automobile to travel within region. Car travel represents approximately 5% of employee's time and a valid driver's license. Qualifications Knowledge and Requirements Proficient in Microsoft Office Suite Must have valid state-issued driver's license in good standing and be able to drive an automobile. Education and Experience College degree preferred (or commensurate industry experience) 5+ years of experience in the insurance industry 3+ years of experience in claims handling (Workers' Compensation preferred) Or 3+ years of electronic data balancing and error correction Associate in Claims, Senior Claim Law Associate Designation preferred Insurance Claims Adjuster License Total Rewards Selective Insurance offers a total rewards package that includes a competitive base salary, incentive plan eligibility at all levels, and a wide array of benefits designed to help you and your family stay healthy, achieve your financial goals, and balance the demands of your work and personal life. These benefits include comprehensive health care plans, retirement savings plan with company match, discounted Employee Stock Purchase Program, tuition assistance and reimbursement programs, and paid time off plans. Additional details about our total rewards package will be provided during the recruiting process. The actual base salary is based on geographic location, and the range is representative of salaries for this role throughout Selective's footprint. Additional considerations include relevant education, qualifications, experience, skills, performance, and business needs. Pay Range USD $59,000.00 - USD $85,000.00 /Yr. Additional Information Selective is an Equal Employment Opportunity employer. That means we respect and value every individual's unique opinions, beliefs, abilities, and perspectives. We are committed to promoting a welcoming culture that celebrates diverse talent, individual identity, different points of view and experiences - and empowers employees to contribute new ideas that support our continued and growing success. Building a highly engaged team is one of our core strategic imperatives, which we believe is enhanced by diversity, equity, and inclusion. We expect and encourage all employees and all of our business partners to embrace, practice, and monitor the attitudes, values, and goals of acceptance; address biases; and foster diversity of viewpoints and opinions.