Claim Compliance Director

JOB DESCRIPTION

Chubb North America Claims seeks a Claim Compliance Director to assist with and manage the day-to-day operations of the Chubb Quality Assurance and Compliance Programs associated with Workers' Compensation Direct and Third-Party Administrators (TPAs), Accident & Health and Personal Injury Protection (PIP) claims.

RESPONSIBILITIES


* Assists with NA Claims market conduct examinations, audits, data calls and other state and federal inquiries, inclusive of the preparation of management and remediation action plans associated with Workers' Compensation, A&H and PIP.


* Assist with and develop audit/compliance related responses to ad hoc audit requests and inquiries from various State regulators.

Ability to assess, dissect, and craft a response to each matter independently for each State is a key responsibility of this role.


* Assists with various state and federal surveys, investigations, assessments and evaluations related to workers' compensation, LSHWA and DBA.

Experience with EDI reporting strongly preferred, as well as analyzing data sets to identify root cause trends.


* Work with North American Claims QA and Compliance Manager to ensure compliance in developing areas of insurance laws and regulations.

Assist with focused audits from regulators and resulting Management Action Plans as required by the State.

Provide recommendations and strategies for resolutions.


* Conduct independent regulatory research in conjunction with legal resources, North American Claims QA & Compliance Manager and others based on evolving regulatory landscapes.


* Monitor regulatory changes that may impact the various lines of business and insurance programs.

Identify gaps, weaknesses, and deficiencies, and create ongoing improvements in claim compliance.


* Serve as a valued resource for Claims Operations, Claims IT and Claim Optimization on critical workers' compensation, A&H and PIP claims regulatory and technical issues to ensure effective and efficient claim handling processes.


* Complete focused niche reviews based on jurisdictional compliance needs in areas of paramount importance for Chubb.

Will closely collaborate with the Chubb NA Quality Assurance team on targeted and focused reviews.


* Monitor TPA action plans against ongoing results and re-evaluation as needed

ABOUT US

Chubb is a world leader in insurance.

With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients.

The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.

At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it.

Our policy is to provid...