Compliance Analyst
Core
Monitor, analyze, and ensure adherence to federal and state claim-related regulatory requirements, including workers' compensation EDI and CMS reporting.
Role type
Compliance Analyst (Workers' Compensation & Regulatory Reporting)
Builds
Regulatory reports, dashboards, and tracking tools for claims compliance
Domain
Insurance (Workers' Compensation, P&C)
Deliverable
dashboards & analysis
Required skills
Regulatory compliance analysis, EDI reporting (FROI/SROI), CMS Medicare Secondary Payer reporting, data reconciliation, root-cause analysis, documentation
Preferred skills
Insurance claims experience, Guidewire ClaimCenter, workers' compensation EDI knowledge, CMS Section 111 reporting
Technologies
Microsoft Office (Word, Excel, PowerPoint), Guidewire ClaimCenter
Responsibilities
Support state workers' compensation EDI reporting and NCCI/IDC reporting; Analyze regulatory changes and translate requirements into business/data needs; Maintain documentation of reporting requirements and deadlines; Develop compliance reports and dashboards; Perform data reconciliation and exception analysis; Coordinate with Claims, IT, and vendors to resolve reporting issues.