Campus Pride Jobs

This role covers Medicare and Compliance. Responsible for the development and execution of the strategic direction of the compliance department, including statutory compliance across the claims organization. Responsible for timely responses to State & Federal Regulators, including, but not limited to: market conduct surveys, AM Best Reviews, etc. on behalf of the overall claims organization. Partners with Corporate Legal, QA Unit Leader, and other claim leaders to perform compliance audits and to respond to the annual NAIC market conduct data call. Strategy Execution - Responsible for the development and execution of the strategic direction of the compliance department, including statutory compliance across the claims organization, and including Medicare, internal audit, state specific compliance, etc. Partners with Corporate Legal Department and claims business partners to ensure compliance with corporate policies and procedures. Is a member of the claims leadership team and a recognized technical subject matter expert (SME) in claims compliance. Regulatory Intermediary - Serves as primary contact to ensure timely responses by the responsible area to market conduct surveys, AM Best Reviews, external complaints, etc. on behalf of the overall claims organization. Collaboration/Subject Matter Expert (SME) - Collaboration - Collaborates with internal/external business partners, seeking and/or providing assistance or input when needed to support Claims business strategies and processes. May serve as a subject matter expert to the various business units. Talent Management - Performs talent management responsibilities including employee selection, performance management, coaching, and development. Manages priorities, workload distribution, hybrid workforce, and removes barriers that impede progress. Completes all personnel, salary administration, and reporting duties. Performs operational responsibilities that drive team performance including planning, execution, process improvement and best-practice sharing. Responsible for work quality, customer service, ensuring adequate reserves. Data Analysis - Gathers, organizes, and analyzes performance data and results to identify and report performance, trends, and opportunities; makes recommendations regarding areas of improvement. Creates reports and communicates results with claims leadership, agents, and business partners. Liaison/Facilitator - Acts as primary liaison & facilitator between Claims and Internal Audit as well as Corporate Legal & Compliance. Researches, develops, and recommends action plans related to Internal Audit findings. Addresses and resolves claims compliance issues as identified by Corporate Legal & Compliance. Communication - Maintains effective and ongoing communication with claims department leaders and staff, internal and external business partners, insureds, claimants, agents, attorneys, other insurance companies, project team members, claims leadership, and vendors. Audits - Partners with Corporate Legal, QA Unit Leader, and other claim leaders to perform compliance audits and to respond to the annual NAIC market conduct data call. Adjuster Licensing - Responsible for ensuring appropriate adjuster licensing compliance and managing related tools, if applicable. National Leader Assistance - Assists national leader with business planning, processes, guidelines, and budget; is accountable for department expenditures. Also assists national leader with identification of risk and mitigation strategies related to compliance-related issues. Training - Partners with Westfield University to design, develop, and deliver compliance-related training to claims professionals. Reviews and approves content of all compliance-related training materials and programs prior to implementation. May create and deliver other ad-hoc compliance training as needed. Industry Research/Best Practices - Remains current