Position OverviewThe Claims Compliance Strategy Specialist is an exempt position that reports to the Director, Claims Strategy. This role evaluates, advises on, and supports business adherence requirements across the claims organization to help ensure compliance with regulatory, reporting, and operational standards. The Claims Compliance Strategy Specialist monitors laws, regulations, and reporting requirements; assesses business and system impacts; partners with information technology and business stakeholders on project implementations; and identifies opportunities to improve processes, reduce risk, and strengthen compliance. This position serves as a resource on claims business adherence requirements and supports the successful implementation of regulatory, reporting, and operational changes across the organization.
Location & Remote Eligibility Open to individuals within range of our offices located in Sandy, UT; Las Vegas, NV; Englewood, CO; Meridian, ID; Sacramento, CA; or fully remote for those outside of reasonable commuting distance. Please note that remote employees may be expected to travel to our Sandy, Utah headquarters for team collaboration events.
Qualifications- Bachelor's degree or appropriate combination of insurance industry claims designation(s).
- Minimum five years of commercial insurance experience, at least two of which in compliance or regulatory reporting.
- In depth knowledge of Medicare, insurance reporting bureaus, and state-specific laws and reporting requirements.
- Excellent regulatory, legal research and analytical skills.
- Excellent communication, interpersonal, and organizational skills.
- Ability to work at both strategic and technical levels.
- Strong background and experience in process improvement and data analysis.
- Ability to understand reporting requirements, system functionality and communicate required changes.
- Ability to work independently.
Essential Job Functions- Monitor accuracy, acceptance, and changes related to regulatory agencies' requirements.
- Monitor and analyze commercial claim laws and regulations that may affect WCF's claims handling policies and practices.
- Research, identify and QA potential areas of risk for the claims department.
- Review, advise and participate in IT project implementation.
- Partner with IT to ensure systems and processes meet business adherence standards.
- Bring cross-functional teams together to prioritize, develop and implement necessary changes.
- Assist other internal departments with understanding and implementing requirements for business adherence.
- Assist with any regulatory audits, DOI and market conduct exams.
Accountability & Requirements- Stay current on all commercial insurance claims law and regulation changes.
- Action and results-oriented, with ability to operate at both a strategic and operational level.
- Keep leadership informed of business-adherence related developments in a timely manner.
BenefitsWCF Insurance offers an extensive compensation package. Benefits include:
- Medical, dental, and vision insurance.
- Company paid life insurance
- 401K with a generous 6% employer match
- Employee Assistance Program (EAP)
- Time off to volunteer in the local community
- All employees earn 4 weeks of vacation their first year.
The expected salary range for this position is 98,000.00-122,400.00. This salary range depends on experience, education, and location for this specific position.
Current WCF Employees Please apply through the "Internal Job Postings" tab within your employee Workday account.
Values The person in this position must demonstrate the WCF values of doing the right thing, being great at your job, and helping others succeed to fulfill the company's mission of excellence.
Working ConditionsThis position is based in an office environment with adequate temperature and lighting control. There are no known hazardous or unpleasant conditions caused by noise, dust, or other environmental factors. There are potentially high-stress situations that require meeting deadlines. The employee must meet the job attendance requirements for this position.
