Claims Compliance Analyst

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Position Overview

The Shared Services Team is seeking a new team member who thrives in a highly collaborative team-oriented environment. The Claims Compliance Analyst will report directly the Vice President of Claims Compliance. The Claims Compliance Analyst position requires supporting the Claims organization with all facets of general compliance requirements, including reconciling, regulatory reporting and responding to compliance related inquiries.

Responsibilities:

Audit Coordination

• Serve as an initial contact and assist with the coordination of Claims Audits that are conducted by the various State DOIs. Will serve as primary intermediary between the business, handling entity, and the State Departments.

• Receive and interpret preliminary audit requests by the State Departments. Analyze and assess audit reports that are issued by the State Departments to identify performance issues. Communicate the results to Arch Claims Senior Leadership TPA Corporate Contacts (if applicable).

• Assist with the review of state report cards and metrics on claims processing and reporting and work with TPAs and Arch staff to remediate any issues.

Regulatory Reporting

• Gather data from TPAs and/or Arch data reports to prepare Compliance managed regulatory reports and data calls. Timely submit state specific annual/quarterly reports where required.

• Review and analyze Claims Bulletins related to Regulatory Reports, communicate internally and/or to the TPAs as needed, and monitor implementation of new requirements where appropriate

• Assist with Electronic Data Interchange (EDI) reporting

Other Compliance Activities

• Support maintenance of compliance library and claims correspondence

• Provide compliance support for Medicare Reporting

• Assist with internal audit and regulatory reviews

• Other ad hoc compliance related tasks, as needed.

Experience and Required Skills:

• General P&C claims knowledge, adjusting experience preferred

• Efficient organization and project management skills

• Familiarity with the suite of Microsoft products such as Excel, Word, PowerPoint, etc.

• Ability to effectively communicate ideas, issues and solutions.

Education

• Bachelor's degree required

• 2 + years Commercial Lines Claims Experience

• Ability to communicate effectively with internal and external business partners as well as state regulatory authorities

• Familiarity with Medicare Secondary Payer (MSP) and Section 111 Reporting

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For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible.

$71,900 - $97,110/year

• Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future.

November 25, 202514400 Arch Insurance Group Inc.