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NJM Insurance Group · 2 months ago

Workers' Compensation Quality and Compliance Analyst, Senior

Parsippany, NJ

Full-time

Hybrid

Senior Level

$83K/yr - $96K/yr

NJM Insurance Group is a company focused on providing quality insurance services. They are seeking a Senior Workers' Compensation Quality and Compliance Analyst to ensure adherence to regulations and company policies while collaborating with internal and external stakeholders to enhance compliance and quality outcomes.

InsuranceManufacturingTransportation

Responsibilities

Assist with coordinating quality and compliance audits/reviews including pre-work such as audit program development and file selection, assuring the review process is proper and timely

Conduct WC Claim audits to ensure adherence to department best practices in addition to state and federal regulations in support of quality claim outcomes, process improvements, data integrity, compliance, and best practices

Collaborate with claims management in the development of meaningful action plans that detail the tasks, resources, and time frames necessary for improvement

Keep current on industry standards

Coordinate and facilitate compliance checklist reviews and report results

Coordinate and facilitate annual reviews for state reference guides, key business contacts, and trading partner agreements

Perform risk assessment and impact analysis to understand consequences and level of exposure

Perform data analysis using data auditing tools/techniques to audit high risk business areas efficiently

Prepare reports including analysis, key findings, potential risks, and identified opportunities for improvement to present to management

Collaborate with the BPU, claims management, law and regulation, and internal audit to ensure the development of claims handling practices are compliant with state and federal regulations

Collaborate with training team to develop resources and training material to support regulatory and Quality Assurance compliance

Attend internal and external QA and Compliance meetings to identify potential changes and communicate same with management

House and maintain records including but not limited to audit results, state and federal regulatory compliance changes, risk assessments, process flows, meeting discussions and action plans

Prepare and submit documentation and/or responses to state and regulatory agencies when directed to by QA Supervisor and/or Administrator

Support QC live indemnity and expense payment audits as needed

Qualification

WC Claims experienceMulti-jurisdictional claims handlingData analysisMicrosoft Office SuiteInsurance designationAnalytical skillsCommunication skillsOrganizational skillsProblem-solving skillsCollaboration skills