Sr Claims Compliance Analyst
Selective is seeking a Sr. Claims Compliance Analyst for either our Charlotte, NC or Branchville, NJ location.
The Sr. Claims Compliance Analyst is responsible for monitoring and proactively managing data transactions between Selective Insurance and regulatory agencies. The Sr. Claims Compliance Analyst will serve as part of the Claims Compliance team and assist the Claims Department with ensuring transactions are completed successfully and timely.
- Partners with claim handlers and claims management to ensure WC EDI transactions are completed in compliance with state regulatory requirements. Responsibly includes analyzing errors, providing guidance on appropriate filings and correcting errors in the appropriate system.
- Partners with claim handlers, claims management and IT to ensure NCCI Detailed Claim Information (DCI) and NCCI Indemnity Data Call (IDC) are completed timely and in accordance guidelines. Position also assists with reporting data to independent bureaus. Responsibility includes creating reports, completing analysis, and correcting errors timely to ensure compliance with regulatory guidelines.
- Position reviews claims regularly to ensure claims are reported in compliance with Medicare Section 111 (Medicare Secondary Payer Reporting Provisions). Responsibility includes creating reports, completing analysis, and correcting errors timely to ensure compliance with regulatory guidelines.
- Identifies on-going claims transactional production issues, conducts root cause analysis, and implements proactive measures to mitigate reoccurrence by taking a leadership role, thinking creatively and outside the box, and setting the example by constantly striving for excellence in all processes and procedures.
- Partner with internal customers on regulatory alerts to help facilitate changes and ensure compliance.
- 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
- Attends training sessions provided by local, state and federal agencies to ensure company is in compliance with regulations.
- Performs other related work as required or requested by management.
- 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
- Advanced PC skills in MS Office (word, excel, power point), Adobe PDF, Internet / Intranet search skills
- Exceptional analytical skills coupled with exceptional oral and written communication skills.
- Strong organizational skills and experience with report generation tools and data analysis.
Selective is an Equal Employment Opportunity employer. Selective maintains a drug-free workplace. #Diversity
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