Claims Compliance Manager (Hybrid)

At Selective, we dont just insure uniquely, we employ uniqueness.

Our Business

Selective is a midsized U.S. domestic property and casualty insurance company with a history of strong, consistent financial performance for nearly 100 years.Selectives unique position as both a leading insurance group and an employer of choice is recognized in a wide variety of awards and honors, including listing in Forbes Best Midsize Employers in 2024 and certification as a Great Place to Workin 2024 for the fifth consecutive year.

Working at Selective

At Selective, we dont just insure uniquely – we employ uniqueness. Employees are empowered and encouraged to Be Uniquely You by being their true, unique selves and contributing their diverse talents, experiences, and perspectives to our shared success. Together, we are a high-performing team working to serve our customers responsibly by helping to mitigate loss, keep them safe, and restore their lives and businesses after an insured loss occurs.

Click to learn more about the Selective Claim Culture and why Selective is right for YOU! https://youtu.be/zuF1YgAyQfo

Job Summary

Accountable for oversight of Selectives Claims Regulatory Compliance function. Responsible for advising and monitoring the Claims Department on compliance, regulatory, and legislative issues impacting claims handling, settlement, and reporting (including NCCI, EDI, Medicare, DCI, and SOX) guidelines, procedures, and processes. Manages the Quarterly Claims Compliance audit process. Strong interpersonal, collaboration, and communication skills are necessary for interacting with all levels of management. Lead, coach, and mentor the Claims Compliance team. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.

Job Responsibilities

• Supervise the Claims Compliance Unit, coordinating and monitoring its activities to deliver timely, professional, competent, efficient, and measurable work product and service levels.
• Develop, maintain, and distribute quarterly Claims Compliance scorecards that analyze and identify compliance issues and trends and report on compliance audits and SOX matters.
• Coordinate with the Claims Department leadership on the Quarterly Claims Compliance audit policies, processes, and procedures, identifying strengths, vulnerabilities, and opportunities. Create and update jurisdictionally-specific regulatory compliance audit protocols by Line of Business to supplement the Claims quality review process.
• Participate in the quality assurance (QA) process, preparing comprehensive reports about observations and recommendations, including identifying and recommending corrective action plans, business owners, and timelines.
• Act as the primary gatekeeper and liaison between Selective, our software and information vendors, the various regulatory and quasi-regulatory bodies, and the Claims Department on legal and regulatory changes and various sources of customer complaints (insurance departments, social media, executive emails and letters, BBB, etc.).
• Oversee the processes and procedures to ensure complaint responses are well-drafted, clearly explain our actions, and appropriately address regulatory and reputational issues.
• Oversee Claims internal appeal/mediation programs, ensuring all are logged, tracked, and timely responded. Conduct periodic analysis of all complaint and appeal activity, reporting on relevant matters and trends.
• Serve as Selectives corporate subject matter expert on critical Claims compliance programs, such as Medicare (set-asides), OFAC, Michigan Medicare Advantage, the Child Support Enforcement program, and the Medicaid Intercept System.
• Continuously assess various compliance program components, recommend improvements, train and mentor regional staff on compliance issues, and identify and engage related experts as appropriate.
• Serve as a subject matter expert on Claims compliance regulatory issues, reading and attending relevant meetings (industry trade association, regulator, and continuing education meetings), as appropriate.

Job Qualifications

• Four-year college degree preferred
• 3 to 5 years of insurance claims handling, settlement, and reporting experience
• Five to seven years of insurance regulatory and/or compliance experience
• IRES certifications desirable
• Supervisory experience, including business strategy development; workload evaluation, assignment of related responsibilities, organizational design, and staff modeling; and performance evaluation and management.
• Extensive understanding of claims handling procedures and reporting, including working knowledge of state and federal laws and regulations.

Selective Insurance offers a total rewards package that includes a competitive base salary, incentive plan eligibility at all levels, and a wide array of benefits designed to help you and your family stay healthy, achieve your financial goals, and balance the demands of your work and personal life. These benefits include comprehensive health care plans, retirement savings plan with company match, discounted Employee Stock Purchase Program, tuition assistance and reimbursement programs, and paid time off plans. Additional details about our total rewards package will be provided during the recruiting process.

The expected starting salary range for this role is $116,000 $167,000. The actual base salary is based on geographic location, and the range is representative of salaries for this role throughout Selectives footprint. Additional considerations include relevant education, qualifications, experience, skills, performance, and business needs.

Selective maintains a drug-free workplace.