Senior Claims Compliance Analyst
About the role
The US Claims Compliance and Quality Assurance team at Hiscox is a dynamic group of professionals dedicated to ensuring consistent and compliant handling of claims across all 50 states. This role is ideal for an experienced claims compliance professional or attorney with a deep understanding of insurance claims regulations, processes, and technology.
Responsibilities
- Manage and maintain a 50-state claims database
- Monitor legislation, DOI bulletins, court reporters/decisions, and statutory changes; manage backlog and implement targeted compliance training
- Develop and own controls related to Medicare, OFAC, Child Support Lien Network, and other federal protocols
- Partner with Claims Technical, US Legal, and IT to design controls and workflows aligned with regulatory requirements
- Lead US Claims response to regulatory inquiries and complaints
- Deliver training and legal support to internal teams and vendors
- Develop audit programs and dashboards to monitor compliance effectiveness
- Oversee/support technology-related compliance integrations
- Provide executive reporting, trends analysis, and regulatory insights
Qualifications
- 10+ years of experience in claims compliance, insurance regulation, or legal operations
- J.D. highly desired; Degree in law, risk management, or a related field; required
- Advanced insurance compliance certifications a plus (CPCU, CIPP, CAMS, CRCM, or similar)
- Scrum/PMP a plus but not required
- Deep understanding of claims handling regulations, Medicare protocols, and market conduct standards
- Experience with multiple lines of business in a 50-state claims environment
- Knowledge of Medicare Secondary Payer requirements and Section 111 reporting
- Strong research and policy writing skills
- Excellent collaboration, project management, and problem-solving skills
- Experience with regulatory audit preparation and response
Pay
$90,000–$150,000 based on experience. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
About Hiscox USA
Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels. Today, Hiscox USA has a talent force of about 420 employees, mostly operating out of several major cities - New York, Atlanta, Chicago, West Hartford, and Scottsdale. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism.
What We Offer
- 401(k) with competitive company matching
- Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
- Company paid group term life, short- term disability and long-term disability coverage
- 24 Paid time off days plus 2 Hiscox days, 10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days
- Paid parental leave
- Financial Adoption Assistance and Medical Travel Reimbursement Programs
- Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
- Company paid subscription to Headspace to support employees’ mental health and wellbeing
- 2024 Gold level recipient of Cigna’s Healthy Workforce Designation for having a best-in-class health and wellness program
- Dynamic, creative and values-driven culture
- Modern and open office spaces, complimentary drinks
- Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation