MSIG USA continues to grow! 

Company Overview:

MSIG USA is the US-based subsidiary of MS&AD Insurance Group Holdings, Inc., one of the world’s top P&C carriers and a global Class 15 insurer, with A+ ratings and a reach that spans 40+ countries and regions. Leveraging our 350-year heritage, MSIG USA brings the financial strength, expertise, and global footprint to offer commercial insurance solutions that address your business’s unique risks.

Claims Compliance Analyst

Position Summary

The Claims Compliance Analyst supports the Claims Regulatory & Compliance function by monitoring, analyzing, and helping ensure adherence to federal and state claim-related regulatory requirements. The position is responsible for analyzing compliance data and trends, supporting workers’ compensation EDI reporting and CMS reporting obligations, and assisting with the identification and resolution of compliance issues.

The role works closely with Claims, Operations, Information Technology, and external vendors to promote accurate and timely regulatory reporting.

Workers' Compensation EDI/IDC

·         Support state workers' compensation EDI reporting, including applicable FROI and SROI transactions.

·         Analyze rejected or failed transactions and assist in determining appropriate corrective action.

·         Analyze claim and transaction data to identify recurring rejection patterns, data-quality issues, and reporting exceptions.

·         Support NCCI and independent bureau IDC reporting.

·         Research jurisdiction-specific EDI requirements, implementation guides, event tables, edit matrices, and reporting deadlines.

Regulatory Compliance Analysis

·         Analyze regulatory changes and assess their potential impact on claim systems, data, reporting, and operational processes.  Translate regulatory requirements into clear business and data requirements.

·         Maintain documentation of applicable reporting requirements, deadlines, data elements, and compliance obligations.

·         Assist with regulatory inquiries, data requests, examinations, and other compliance-related requests.

·         Assist with preparation of

·         Participate in testing of system changes affecting CMS, EDI, or other regulatory reporting.

·         Maintain listing of adjuster licenses

CMS Compliance and Reporting

·         Support compliance with applicable CMS Medicare Secondary Payer reporting requirements, including Section 111 reporting for applicable claims.

·         Analyze CMS reporting data for completeness, accuracy, consistency, and potential reporting exceptions.

·         Research and assist in resolving CMS reporting errors, rejected records, data discrepancies, and other reporting issues.

·         Coordinate with Claims, IT, vendors, and other stakeholders to resolve CMS data and reporting issues.

Data Analysis and Monitoring

·         Develop and maintain compliance reports, dashboards, spreadsheets, and tracking tools.

·         Perform reconciliation and exception analysis of regulatory reporting data.

·         Analyze reporting results to identify trends, anomalies, recurring errors, and potential process gaps.

·         Monitor outstanding compliance issues, corrective actions, regulatory deadlines, and remediation activities.

·         Assist with root-cause analysis of regulatory reporting issues.

Preferred Qualifications

·         Bachelor's degree in business, insurance, risk management, compliance, data analytics, or a related field, or equivalent relevant experience.

·         Experience in insurance claims, regulatory compliance, workers' compensation, or regulatory reporting preferred.

·         Exposure to Guidewire ClaimCenter preferred.

·         Knowledge of workers' compensation EDI/FROI/SROI reporting strongly preferred.

·         Knowledge of CMS Medicare Secondary Payer/Section 111 reporting preferred.

·         Strong Microsoft Office skills, including Word, Excel, and PowerPoint

·         Strong analytical, problem-solving, documentation, and written communication skills.

It's an exciting time for our company and a great opportunity to join a financially sound and growing global insurance group!  

It is the policy of MSIG USA to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, MSIG USA will provide reasonable accommodations for qualified individuals with disabilities.