Senior Claims Compliance Analyst (FPA4)

Duties

• Investigate and analyze complex, high-priority consumer complaints involving insurance claims handling practices and alleged unfair trade practices.
• Conduct independent reviews of claim denials, settlement decisions, coverage determinations, and adjuster conduct to evaluate compliance with insurance laws and regulations.
• Research insurance policies, contracts, claims files, and insurer practices to identify potential violations and determine appropriate resolutions.
• Serve as a technical expert on insurer claims handling standards, unfair claims settlement practices, and insurance regulatory requirements.
• Collaborate with consumers, attorneys, insurance company representatives, and agency staff to resolve disputes and promote fair treatment of policyholders.
• Prepare comprehensive complaint analyses, regulatory findings, and recommendations for corrective or enforcement actions.
• Provide guidance and consultation to agency leadership and staff on complex claims-related and regulatory issues.
• Support investigations and enforcement activities involving unlawful, unfair, or inequitable insurance practices.
• Deliver training and technical assistance to agency staff on emerging claims handling, coverage, and compliance issues.
• Participate in special projects, process improvement initiatives, policy analysis, and cross-agency workgroups to strengthen consumer protection efforts.

Qualifications

• Seven (7) years of professional work experience.
• Relevant experience may include roles such as claims adjuster, insurance compliance analyst, insurance examiner, market conduct examiner, Insurance regulatory analyst, risk management analyst or comparable positions at an insurance company, insurance agency, or at a municipal, state or federal regulatory agency.
• A degree in public administration, social work, public health, business administration finance or related field from an accredited institution whose accreditation is recognized by the U.S. Department of Education or the Council of Higher Education Accreditation, or a foreign equivalent may be substituted for relevant experience.
• Two (2) or more years demonstrated professional level experience with licensure or compliance of regulated entities, including but not limited to financial analysis, audits or examinations, and/or inspection of technical documentation such as business contracts, policies, and agreements.
• Prior experience as a Functional Program Analyst 3 with the Washington Office of the Insurance Commissioner (OIC) performing licensing application reviews, financial analysis/exams, consumer complaint analysis, or comparable experience with the OIC; or comparable experience with another state’s department of insurance.
• Three (3) years of work experience producing work product that demonstrates scrupulous attention to detail and superior writing skills.
• Industry professional designations, such as, Accredited Financial Examiner (AFE), Chartered Property Casualty Underwriter (CPCU), Fellow Life Management Institute (FLMI), Certified Insurance Examiner (CIE), Accredited Insurance Examiner (AIE), Associate, Insurance Regulatory Compliance (AIRC), Associate Professional in Insurance Regulation (APIR), or Professional in Insurance Regulation (PIR).
• Fluent verbal communication skills in Spanish, Korean, Russian, Vietnamese, Mandarin, or Cantonese, with the ability to score “Advanced Mid skill level” on the oral proficiency assessment by the American Council for the Testing of Foreign Languages.