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Claims Audit - Claims Regulatory Compliance Administrator

Company: The Hanover Insurance Group
Location: Worcester
Posted on: January 14, 2020

Job Description:

Friday, January 10, 2020

Our Claims Audit department is seeking a Claims Regulatory Compliance Administrator to join our growing team in our Worcester, MA office.

Position summary:

Conducts claims wide auditing, education and monitoring of claims compliance within each jurisdiction for all Lines of Business claim handling. Monitors and implements new DOI compliance requirements for multiple lines of business and states along with tracking and reporting requirements. This role will effectively communicate with SLT/Regional Leaders/ Unit Managers and Adjusters as a resource to ensure proper execution of compliance related matters.

This is a Full-time/Exempt role.

Responsibilities/Essential Functions:

--- Define, monitor and update compliance policies and procedures for multiple Lines of Business (e.g. - applicable unfair claims practices/settlement laws and regulations/regulatory time frames for various aspects of claims handling)

---Track and report implementation of new and existing DOI requirements as it relates to licensing, claims handling, letters, forms, etc

---Implement procedures to ensure staff and TPAs have understanding of and comply with any applicable federal or state laws pertaining to privacy and protection of personal information of claimants

---Review and update all correspondence content requirements such as forms, letters and fraud language including letter and stationery requirements

---Disseminate DOI announcements to management

---Work with management and Corporate Compliance to respond to DOI requests or market conduct reviews; serve as primary Claims contact for external compliance examinations and communicates exam status with management at appropriate milestones

---Track and monitor standard DOI (Department of Insurance) form submissions for multiple jurisdictions and responsible for making sure they meet state standards, edition dates are current, and necessary forms are accessible

---Review and monitor routine and ad hoc claim compliance reporting including Market Conduct Annual Statement reports and complete state/federal data calls as required

---Field Office Auditing to determine if appropriate claims handling requirements or submissions were completed according to state compliance laws and monitor proper implementation of any resulting corrective actions in conjunction with Corporate Compliance

---Assist Unit Manager on creating and reviewing reports on Adjuster handling adherence to regulatory requirements

---Monthly/quarterly reporting to Corporate Compliance /SLT/Regional Managers/UM as needed

---Identify and monitor claims financial control deficiencies and remediation efforts throughout the year as needed

---Propose remediation strategies and provide insight into process improvement opportunities to LOB claim management

---Perform other control related projects relevant for claims financial control compliance as needed

---Responsible for determining and updating Adjuster licensing requirements for applicable states , lines of business and educating Managers on the initial requirements, continuing education and renewal process

---Audit adjuster licensing compliance and status to ensure appropriate credentialing

---Create trainings and tools to assist Claims Assistants and Claims Adjusters in ensuring quality work product that meets all required regulatory standards

---MSP (Medicare Secondary Payer) compliance support

---Additional ad hoc projects and research as required.

Position Requirements:

--- College degree preferred - advanced degree a plus

---Adequate claim adjusting experience to demonstrate the required compliance competency

---Minimum of 5 years claims adjusting and file audit experience

---Proficient using Claims systems (i.e. CSS, PMS, HCS etc.) Technical knowledge of at least two of the following lines of business: Workers Compensation, Personal Injury Protection, Medical Payments, Liability (GL, HO and Auto), Specialty, Property and Inland Marine Viewed as a senior resource in given field for the department

---A high degree of initiative and effective organization and time management skills

---Strong leadership, negotiation, conflict resolution, written and verbal communication skills and ability to work effectively with front line staff, management and senior leadership

---Sound judgment and sharpened ability to identify the quality of file handling, compliance with state regulations, representation of the Hanover / Citizens brand and the sharing of information

---Recognizes and appreciates differences in people and treats all individuals fairly and respectfully regardless of their background, position, or status. Works effectively with everyone, respects diverse values and viewpoints, looks at issues from multiple perspectives

---Detail oriented

---High level of proficiency in Word, Excel and use of the Internet

---Ability to organize, create, deliver and refine a process, think critically, collaborate, and problem solve

---Knowledge and experience in performing regulatory research and reviewing, analyzing and evaluation relevant statutes, regulations and other regulatory materials a plus

---Ability to use a personal computer and other standard office equipment

---Ability to sit and/or stand for extended periods

---Ability to travel as necessary

---Ability to work in a fast paced, changing or stressful environment.

EEO statement:

"The Hanover values diversity in the workplace and among our

customers. The company provides equal opportunity for employment and

promotion to all qualified employees and applicants on the basis of experience,

training, education, and ability to do the available work without regard to

race, religion, color, age, sex/gender, sexual orientation, national origin,

gender identity, disability, marital status, veteran status, genetic

information, ancestry or any other status protected by law.

Furthermore, The Hanover Insurance Group is committed to

providing an equal opportunity workplace that is free of discrimination and harassment

based on national origin, race, color, religion, gender, ancestry, age, sexual

orientation, gender identity, disability, marital status, veteran status,

genetic information or any other status protected by law."

As an equal opportunity employer, Hanover does not

discriminate against qualified individuals with disabilities. If you

require a reasonable accommodation, as a candidate for employment, please

inform The Hanover Talent Acquisition office.

Other details






  • Job Function

    Compliance



  • Pay Type

    Salary




Keywords: The Hanover Insurance Group, Worcester , Claims Audit - Claims Regulatory Compliance Administrator, Accounting, Auditing , Worcester, Massachusetts

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