Job Number: 10136
Job Number: 260000E4
External Description: About the Role Equitable is looking for an experienced expert to join our team! The
Head of Claims Compliance will oversee all aspects of our
Employee Benefits (EB) Claims compliance framework. Reporting directly to the Head of Claims, this role is pivotal in ensuring compliance with regulatory and legal requirements in the administration of claims for our Employee Benefits product suite, with includes group dental, vision, life insurance, short and long term disability, statutory benefits, paid family leave, as well as supplemental health offerings, including accident, critical illness, hospital indemnity, and associated wellness benefits.
This individual must be able to help deliver Employee Benefits' "Powerfully Simple" vision, by supporting the Employee Benefits claims organization with a rigorous compliance framework.
What You'll Be Doing - Compliance: Ensures all claims processes comply with relevant laws and regulations. Stays current regarding updated changes in legislation and adjusts advice accordingly.
- Key Controls: Establishes and monitors key controls within the EB Claims organization, including SOX compliance. Partners with members of the EB Claims leadership team and internal control functions.
- Audit Oversight: Ensures internal and external audit needs are well-coordinated and serves as the primary point of contact for internal and external claims-related audits, including market conduct.
- Records Management: Serves as the primary contact for items related to claims records management, to ensure full compliance with internal and external guidelines and regulations.
- Business Continuity: Collaborates on the EB Claims business continuity plan and works with internal and external vendor stakeholders to ensure plans are robust and revisited regularly.
- Privacy Liaison: Collaborates with enterprise privacy partners to ensure privacy outages are mitigated and coordinates prevention and control mechanisms related to claims data privacy.
- Performs other duties as assigned.
This position offers a flexible work schedule: it may be fully remote/hybrid. If you are located near one of our offices (e.g., Charlotte, NC; New York, NY; Syracuse, NY), a hybrid schedule with 2-3 days on-site per week is expected to foster collaboration and connection.
The base salary range for this position is
$160,000 - $200,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.
For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.
Equitable Pay and Benefits: Equitable Total Rewards Program
What You Will Bring Required Qualifications
- Bachelor's degree
- 10 years of experience in the Employee Benefits / Group Insurance industry
- 5 years of direct experience with claims compliance in an Employee Benefits setting
- Specific prior experience supporting one or more of the following products: group dental, vision, life insurance, short/long term disability, statutory benefits, paid family leave, and/or supplemental health offerings (accident, critical illness, hospital indemnity, and associated wellness benefits).
Preferred Qualifications
- J.D. degree highly desired
- Experience with FINEOS claims software a big plus
- Strong understanding of compliance and internal controls
- Excellent interpersonal and relationship building skills
- Exceptional verbal and written communication skills
Skills Regulatory Compliance Expertise : In-depth knowledge of laws and regulations related to Employee Benefits claims, ensuring all processes adhere to standards.
Internal Controls Management : Proven ability to establish and monitor key controls within an Employee Benefits Claims organization, including SOX compliance.
Audit Coordination : Experience in coordinating internal and external audits, serving as the primary contact for claims-related audits, and ensuring audit needs are met efficiently.
Data Privacy and Records Management : Strong skills in managing claims records and ensuring compliance with privacy regulations, including collaborating with privacy partners to ensure strong data protection.
Business Continuity Planning : Ability to maintain and regularly update the business continuity plan, ensuring robust strategies are in place in collaboration with internal and external stakeholders.
Communication and Collaboration : Excellent verbal and written communication skills, with the ability to build strong relationships and collaborate effectively with various teams and stakeholders.
Problem-Solving and Analytical Skills : Competence in dealing with complexity and ambiguity, utilizing analytical skills to explore multiple solutions and drive continuous improvement in internal controls.
Community / Marketing Title: Head of Claims Compliance, Employee Benefits (REMOTE)
Location_formattedLocationLong: 
