Workers' Compensation Quality and Compliance Analyst, Senior Job Listing at NJM Insurance Group in Trenton, NJ (Job ID R2007301)

Description

Reporting to the Workers' Compensation (WC) Training and Quality Assurance Management Supervisor, the WC Quality Assurance/Compliance Analyst is responsible for ensuring adherence to state and federal regulations, identifying and minimizing risks, and adherence to company policies and procedures for multiple jurisdictions.

This position requires partnering with various external customers and all levels of internal management to analyze and communicate findings, recommend solutions and work collaboratively in the development of meaningful action plans.

This position is Hybrid requiring 3 days in the office and 2 days remote. There is flexibility to be based in Hammonton, West Trenton, or Parsippany.

Essential Duties and 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.  

Required Skills and Experience:

• WC Claims experience and strong knowledge of process and procedures.
• Strong understanding of multi-jurisdictional claims handling and regulatory requirements.
• Proficient in Microsoft Office Suite: Excel, word, Power Point.
• Ability to collect and analyze complex data sets to identify root causes/trends and quantify the “cost of non-compliance).
• Strong verbal and written communication skills.
• High level of motivation: self-starter, ability to prioritize and coordinate tasks.
• Must have excellent organization and time management skills.
• Detail oriented with strong analytical and problem-solving skills.
• Must be highly collaborative and open to multiple perspectives.
• Ability to manage several tasks and/or projects at the same time.
• Must be able to work independently

Required Qualifications:

• Bachelor's degree and/or proven insurance related experience.
• Minimum 5 years of Worker's Compensation claims handling experience
• Insurance designation preferred
• Regional Workers' Compensation claims handling experience a plus.
• Must be able to travel to all three offices.

Compensation: Salary is commensurate with experience and credentials.

Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses.

Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.