Manage all assigned complaint cases from intake through resolution within the complaint CRM system.
Ensure timely contact with complainants and internal stakeholders.
Coordinate with Claims teams to validate facts, obtain updated information, and ensure commitments are completed.
Draft clear, defensible, and well-supported written responses to regulatory bodies and consumers.
Assemble and validate claim file materials, correspondence, and required documentation for regulatory responses.
Monitor and meet all internal and external complaint service-level agreements (SLAs).
Maintain complete, accurate, and compliant case documentation.
Prepare timely submissions for state Departments of Insurance (DOI) and other regulatory agencies.
Identify potential compliance issues, trends, or risks and escalate appropriately.
Support regulatory exams, inquiries, and operational reviews by gathering data and documentation.
Execute tasks related to Medicare Section 111 exception validation and related reporting workflows.
Produce routine and ad hoc complaint reporting, reconciliations, and dashboards.
Analyze complaint trends to identify systemic issues or operational improvement opportunities.
Ensure accurate root-cause coding and complaint disposition entry.
Collaborate with Claims, Legal, Quality, Compliance, and leadership teams to support complaint resolution and regulatory adherence.
Provide feedback on opportunities to improve processes, communication, customer experience, and compliance posture.

At least 2 years’ experience in claims, compliance, audit, customer escalations, or related insurance functions.
Experience handling property or housing-related claims preferred.
Knowledge of state insurance regulations, consumer protection requirements, and claims-handling standards.
Strong written communication skills for regulatory responses and documentation.
Experience with CRM systems or case-management tools.
Associate degree required; Bachelor’s degree preferred.
Preferred Qualifications Knowledge of state insurance regulations, consumer protection requirements, and claims-handling standards.
P&C Adjuster's license

Compliance Specialist – Complaints, Global Housing Claims

Key skills