Fond du Lac, WI, US
Job Title: Compliance Analyst
Employment Status: Exempt; Full-Time
Position Location: Hybrid / Remote Work Options available within states Society does business in
Schedule: 40 hours/week with flexible scheduling opportunities
Protecting our policyholders’ dreams, passions, and livelihoods has a direct impact on the communities we serve. We work towards excellence, conduct ourselves with high integrity, and take our work seriously, but not ourselves. Small Details. Big Difference. Find out how you can make a difference with a career at Society.
Society Insurance is seeking an experienced Compliance Analyst to join our Property, Auto, & Liability (PAL) Claims Team. This Compliance Analyst will ensure all required claims information and data for both Workers’ Compensation and Property/Auto/Liability are reported timely and accurately to appropriate federal and state lienholders (notably Medicare) as well as provide Medicare claims consultation and training to the departments.
About the Role
- Provides support and maintains compliance across the Workers’ Compensation and Property/Auto/Liability claims units.
- Ensures that all required data is reported to lienholder timely and accurately per lienholder guidelines.
- Develops and conducts training to ensure that adjusters are up to date with lienholder guidelines and industry developments.
- Provides technical direction to Claims Representatives as requested.
- Coordinates and protects future exposures by gathering info to complete an MSA.
- Analyzes current business processes and workflows for compliance and prepares revision recommendations in order to maintain compliance.
- Participates in investigations and resolution of any fines, penalties, or inquiries from lienholders.
- Audits claims files for lienholder compliance.
- Reviews error reports and contacts adjusters to correct errors on a timely basis.
- Acts as point of contact between lienholder Electronic Data Interchange (EDI) representative and Society’s Information Technology department (IT) to facilitate resolution of EDI issues.
- Builds, maintains, and distributes appropriate compliance reports for management review.
- Performs additional lienholder or other compliance responsibilities as needed.
- Handles moderate to severe claims on an as-needed basis by determining insurance carrier’s liability; reaching agreement with claimant according to policy provisions and authority level; handling mediations, arbitrations, and subrogation within authority level.
- Maintains professional and technical knowledge by attending continuing education classes and courses.
- Contributes to team effort by participating in department projects as needed.
- You are analytical and take a deliberative decision-making approach.
- You are curious and enjoy resolving discrepancies.
- You are comfortable analyzing, investigating, and using the facts to make decisions.
- You like taking a systematic approach in making process improvements.
- You are organized and can manage multiple responsibilities.
What it Will Take
- Associate degree and 3 years of claims-handling – OR – at least 5 years of claims-handling experience involving discretionary decision-making and increasing levels of claims severity including specialized coverages and loss adjustments.
- Knowledge of International Classification of Disease (ICD) codes and medical terminology.
- Familiarity with PC applications including word processing, Internet, spreadsheets, and e-mail software.
- Valid driver’s license and a satisfactory driving record as determined by Society Insurance.
- Technical proficiency in lienholder (Medicare) compliance reporting requirements highly desirable.
- Professional insurance designations of AIC, ARM, CIC, or equivalent coursework highly desirable.
What Society Can Offer
- Comprehensive Benefits Package: Salary with bonus plan; health, dental, life, and vision insurance
- Retirement: Traditional or Roth 401(k) Defined Contribution Plan PLUS Profit-Sharing Plan
- Work-Life Balance: Company-paid holidays; flexible scheduling; PTO; telecommuting options
- Education: Career Coaching; company-paid courses; student loan and tuition reimbursement
- Community: Charitable Match; paid volunteer time; team sponsorships
- Wellness: Employee Assistance Program; health club reimbursement; wellness reimbursement
Society Insurance prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, handicap, disability, genetics, veteran status or military service, marital status or sexual orientation, gender identity or expression, or any other characteristic or status protected by federal, state or local laws. Society Insurance also provides reasonable accommodations to qualified individuals with disabilities in accordance with the requirements of the Americans With Disabilities Act and applicable state and local laws.
Society Insurance is a drug-free workplace. Any candidate who receives an offer of employment from Society will be required to undergo a pre-employment drug test for controlled substances. All offers of employment are contingent upon successful completion of the pre-employment drug test, which is conducted in accordance with Society’s substance abuse policy.