at Chubb in Chicago, Illinois, United States
Job Description
JOB DESCRIPTION
The Workers' Compensation/A&H Claims Department is currently seeking an AVP, Compliance Director candidate to partner with discipline leadership in support of NA Claim Business unites to develop strategies and solutions that will drive executive of our compliance-related initiatives. All employees are required to work from a regional claim office (Chicago, Dallas, Los Angeles, Alpharetta, or New Haven) for a minimum of 3 days per week.
MAJOR DUTIES AND RESPONSIBITIES:
- Drive quality execution of Compliance within the WC/A&H Discipline
- Develop key relationships with internal business teams to ensure holistic Compliance solutions; Quality Assurance, Claim Compliance, Government Affairs, General Counsel and other related business units
- Design, develop and execute strategies to meet quality expectations of the NA Claim Department
KEY ACCOUNTABILITY AREAS:
- Serve as the business representative for state agency relationships. Co-ordinate State Audits and Data Calls that includes preparation/data retrieval and engagement with the state regulator representatives. Partner with discipline leaders to analyze post-audit findings to develop solutions for improvement in identified audit areas.
- Track NA Claim Compliance Alerts; Partner with field leadership to interpret changes in jurisdictional regulatory demands and drive necessary changes to region workflow processes. Develop interim checkpoints/measurements to ensure changes are implemented and meet regulatory expectations.
- Partner with the Government Affairs team (GA) to coordinate Claim Subject Matter Expertise opinions regarding GA notifications of proposed legislation changes. Craft follow-up responses that assist GA to understand potential impacts to the discipline/industry.
- Discipline owner to engage in Department of Insurance/Better Business Bureau complaint protocols, determine necessary discipline resources to respond, trend frequency for areas of opportunity.
- Claim discipline owner of Electronic Data Interchange (EDI) and vendor partner EBIX relationship manager. Track and trend EDI shortfalls and root causes for unsuccessful results. Analyze jurisdiction results, current workflows and systems to develop improvements for EDI compliance. Serve as project lead for all related technology/system improvements.
- Liaison with WC Medical Management leadership to support medical vendor partner compliance and promote staff awareness to changes in WC Fee Schedules, Utilization Review regulations and other Medical Management Compliance focused areas.
- Partner with discipline leaders to develop and track action plan strategies that maintain favorable findings and improve unfavorable findings from Quality Assurance Compliance Audits.
- Serve as project lead for all Compliance related system enhancements and maintenance; Improvements to WC Forms & Correspondence, EDI, and other identified technology enhancements.
- Leverage all Key Accountability areas to design and deliver comprehensive Training programs that ensure quality focus on Compliance within the discipline
EDUCATION/REQUIREMENTS:
- Strong technical background in the Workers' Compensation/Accident & Health Claim discipline
- College degree or equivalent business experience
- Project/Change Management experience that involves coordination of cross-discipline teams
- Proven analytical, organizational and communication skills for business solution design and interaction with internal/external business partners ...
Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
