Compliance & Quality Specialist, REMOTE
AF Group

Job Info

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REMOTE Opportunity within the U.S.
Must be able to work EST/CST work hours.

SUMMARY

Acts as a leader and technical expert to identify and resolve enterprise compliance and premium audit quality issues. Responsible to ensure business requirements are met, defects are resolved timely and adequately, and communicate new processes. Responsible for compliance oversight. Performs compliance and audits focusing on state specific audits, compliance audits of core functions, adherence to the Company's standards and practices, reserving and financial outcomes. Builds a consistent view of quality through calibration. Leads compliance and quality activities as new states are entered and creates robust self-monitoring plans. Key partner in action plan development with accountability for action plan completion. Central point of contact with internal stakeholders. Manages vendor relationships related to regulatory reporting and compliance activities.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Perform audits as assigned including but not limited to quality assessments which may require calibration, risk assessments, reserve oversight, compliance focused state specific audits, and compliance audits of core functions with high regulatory oversight.
• Draft audit reports, maintain audit schedules, and collaborate with stakeholders to develop plans of action and ensure execution and completion of action items.
• Enterprise technical expert responsible for researching, monitoring and making recommendations including but not limited to state and federal rules and regulations, industry & the Company benchmarks, complex case management, reserving and the Company standards and practices.
• Lead and coordinate components of external state and federal audit requests.
• Drive execution and resolution of identified compliance issues including but not limited to
• developing and directing plans for response to state and federal rules and regulations that impact the Company.
• Build, audit and report on self-monitoring activities including but not limited to the effectiveness of the Company compliance with state and federal rules, adherence to our S&P around handling of insurance department consumer complaints, penalty resolutions and authorities, and compliance with state reporting bureau data.
• Audit enterprise standards and practices for handling of state and other audits.
• On behalf of the enterprise, manage vendor relationships related to regulatory reporting, auditing and compliance activities.
• Central point of contact on compliance issues for the OGC, OGACC, Finance, Actuarial, and Governmental Relations.
• Lead activities on new state entry process to ensure compliance with state requirements.
• Build and maintain a compliance library and an historical tracking of regulatory activity and claim handling changes that includes a description, impact to the Company statement, and action taken to track and report on all activity.
• Monitor and report on regulatory updates from OGC and Regulatory Services; Ensures appropriate action is taken.
• Identify training needs based upon audit findings and state/federal regulatory rules and changes. Serve as a subject matter expert in support of compliance and related training initiatives.
• Represents the department and corporation on various committees and events as appropriate.
• Performs special projects, as assigned.
• Maintains confidentiality of all information processed.
• Serve as a mentor and resource to other staff.

EDUCATION AND EXPERIENCE Relevant combination of education and experience may be considered in lieu of degree.

• Bachelor's degree in insurance, business or a related field.
• Five years in Property and Casualty or compliance environment required.
• Demonstrated technical knowledge in three or more of the following areas: compliance research and oversight, case management, case reserving, auditing, vendor management, NCCI or similar knowledge that provides the necessary skills, knowledge and abilities. Multi-state experience or compliance auditing preferred
• Progress towards or completion of, industry-recognized professional designations preferred.
• Certification or progress toward certification is highly preferred and encouraged.
• Continuous learning, as defined by the Company's learning philosophy, is required.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

OTHER SKILLS AND ABILITIES

• Extensive knowledge of Property and Casualty lines of insurance with specific knowledge in one or more of the following areas: state and federal compliance rules and regulations, Medicare compliance, industry and the Company benchmarks.
• Ability to exercise sound, consistent judgment in evaluating and recommending compliance and handling action.
• Ability to read, interpret and understand contract language.
• Knowledge of ability to analyze and interpret law, federal and state rules and regulations, jurisdiction and compliance. Knowledge of ability to analyze and interpret insurance law, federal and state rules and regulations as it relates, jurisdiction and compliance. Excellent oral and written communication skills.
• Excellent analytical skills to identify improvement opportunities, develop solutions and assess impact.
• Ability to interact with all levels of internal staff and management, and effectively exchange information clearly and concisely, present ideas, report facts and other information, as well as respond to questions as appropriate.
• Strong interpersonal skills with well-developed conflict management/negotiation and presentation skills.
• Ability to manage multiple projects and meet necessary deadlines with minimal direction.
• Ability to perform necessary mathematical computations.
• Ability and proficiency in the use of computers and company standard software specific to position.
• Ability to maintain confidentiality.
• Ability to perform other assignments at locations outside the office.

ADDITIONAL INFORMATION

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.

WORKING CONDITIONS:

Work is performed in an office/remote environment with minimal hazards. Travel as required.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

Pay Range: Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $70,400 and $117,800.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.

#LI-MG1 #AFG

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