Corporate Claims Compliance Specialist

Posted Yesterday
Be an Early Applicant
6 Locations
In-Office or Remote
Senior level
Insurance
The Role
Analyzes insurance regulations and legislation, evaluates operational impacts, monitors compliance action plans, coordinates claims and rate system revisions, prepares regulatory submissions, investigates consumer complaints, conducts compliance assessments and audits, and supports operating companies with regulatory requirements. Provides guidance to associates and applies expertise in workers’ compensation regulations, insurance contracts, state audits, EDI compliance, and claims operations.
Summary Generated by Built In
Job Summary & Responsibilities
Under the technical direction of the AVP of Compliance and Claim Operations, the Corporate Compliance Specialist will works within defined limits and authority on assignments of higher technical complexity and coordination. Possesses demonstrated technical insurance industry knowledge and skills, including state, federal and industry compliance regulations, reflective of successful progression through various job family levels. May provide guidance and assistance to lower-level associates and other functional areas.
 
Responsibilities -
  • Analyzes and interprets state, federal and industry insurance legislation and regulations
    determining the potential impact on company operations.
    * Monitors timely implementation of action plans to ensure compliance with regulatory changes.
    * Plans and implements system revisions for rates, rules and claim handling changes.
    * Reviews APCIA, industry notices, Insurance Department bulletins and enacted laws for changes
    relative to claim forms, printed material, and necessary operational changes.
    * Coordinates and prepares the necessary forms and regulatory material for submission to state
    insurance departments to review or Claim Operations for implementation.
    * Receives and performs initial analysis of consumer complaints and state insurance department
    inquiries.
    * Completes compliance assessments, including research, file reviews, audits and business unit
    secondary review.
    * Works closely with supported Operating Companies to ensure their compliance needs and
    requirements are met.
  • Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.
#LI-Remote
Preferred Qualifications
  • Bachelor's' degree or 5 or more years of equivalent work experience in an insurance related industry required.
  • Chartered Property Casualty Insurance (CPCU) and Associate in Claims (AIC), or similar professional designation, desired.
  • Obtains and maintains state adjusting licenses, as necessary. Ensures that all state-required Continuing Educational Credits are obtained as needed to maintain license.
  • Previous supervisory experience
  • Extensive knowledge of WC regulations and applicable law, preferably in multiple jurisdictions.
  • Demonstrated leadership, coaching, and teamwork skills.
  • Extensive knowledge of insurance contracts, insurance technical constructs and structures; previous state regulatory/audit experience; experience with EDI compliance requirements
  • Advanced skills in applying sound judgment/analysis, decision making/problem solving, planning and organization and negotiation.
  • Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.
  • Demonstrated customer service and collaboration skills.
  • Excellent verbal and written communication skills.

Skills Required

  • Bachelor's degree or five or more years of equivalent work experience in an insurance-related industry
  • Chartered Property Casualty Insurance (CPCU), Associate in Claims (AIC), or similar professional designation
  • State adjusting licenses, as necessary, and required continuing education credits
  • Previous supervisory experience
  • Extensive knowledge of workers' compensation regulations and applicable law across multiple jurisdictions
  • Leadership, coaching, and teamwork skills
  • Knowledge of insurance contracts, insurance technical structures, state regulatory audits, and EDI compliance requirements
  • Advanced judgment, analysis, decision-making, problem-solving, planning, organization, and negotiation skills
  • Computer literacy and working knowledge of Microsoft Office, including Word, Excel, and PowerPoint
  • Customer service and collaboration skills
  • Excellent verbal and written communication skills

PMA Companies Compensation & Benefits Highlights

The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about PMA Companies and has not been reviewed or approved by PMA Companies.

  • Leave & Time Off Breadth — Time off is described as generous, with a sizable PTO bank and a broad paid-holiday schedule. Feedback suggests the ability to accrue and use substantial leave is a standout element of the package.
  • Retirement Support — Retirement support includes a 401(k) with company contributions and immediate vesting on certain employer dollars. Profit-sharing and automatic eligibility are positioned as meaningful additions to total rewards.
  • Flexible Benefits — Benefits are organized in a cafeteria-style format with multiple medical plan choices, HSA options, FSAs, and a broad set of voluntary coverages. Feedback suggests this flexibility enables tailoring coverage to individual needs.

PMA Companies Insights

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The Company
HQ: Blue Bell, Pennsylvania
1,511 Employees
Year Founded: 1915

What We Do

PMA Companies provides risk management solutions and services, specializing in workers’ compensation and offering property & casualty insurance, in the United States. Headquartered in Blue Bell, PA, PMA Companies is a member of Old Republic Companies. Old Republic International Corporation (NYSE: ORI) is one of the nation’s 50 largest publicly held insurance organizations. PMA Companies includes: PMA Insurance Group, specializing in workers’ compensation, and providing other commercial property & casualty insurance products; and PMA Management Corp. and PMA Management Corp. of New England, providing results-driven TPA and Risk Services specializing in workers’ compensation and liability. We maintain a large client retention rate of 90% or higher and a client satisfaction rate of 96% per an independent survey. At PMA, we still build relationships the "old-fashioned way."​ Our clients know we care. They know we say what we do and do what we say. And they know that they can count on us to deliver tangible value to their business and to work passionately on their behalf.

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