Associate Director, Claims Compliance
Core
Leads a team of analysts to investigate regulatory inquiries, respond to market conduct exams, and ensure adherence to state and federal regulations for health insurance claims.
Role type
Senior IC Associate Director (Claims Compliance)
Builds
Regulatory response strategies and claims compliance workflows
Domain
Health Insurance / Regulatory Compliance
Required skills
Claims operations and processing, Regulatory inquiry investigation, People management, Regulatory agency collaboration, Process improvement, Strategic planning, Team leadership, Cross-functional collaboration
Preferred skills
Benefit and contract interpretation, Medicare or Commercial claims experience, Technical team collaboration, Data-driven analysis
Responsibilities
Direct and coordinate claims processes including research, adjustments, and regulatory inquiries. Lead a team of claims analysts specializing in regulatory compliance. Supervise and train managers and employees. Collaborate with regulatory agencies, legal, audit, and compliance teams. Translate department strategy into business plans to meet operational KPIs.
Seniority
Senior, hands-on IC with team leadership