Monitor changes in state, federal, and market conduct regulatory requirements impacting claims handling and TPA activities
Ensure TPA partners maintain compliance with claims regulations, including timeliness standards, documentation rules, licensing requirements, privacy laws, and unfair claims practices statutes
Identify compliance risks and support corrective action plans with internal stakeholders and TPA leadership
Prepare and support responses to Department of Insurance (DOI) inquiries, data calls, market conduct exams, and regulatory filings related to TPA-handled claims
Serve as a liaison between Claims, Compliance, Legal, and external TPA partners
Support the response to and compliance with state regulatory audits and fines

Bachelor’s degree in business or related field and/or equivalent combination of experience; insurance or financial services industry preferred
Minimum 5 years prior experience working with TPAs in the NAM regulatory space
Knowledge of regulatory best practices and state, province, and carrier requirements
Understanding of quality controls and risk management disciplines is a strong asset
Proficiency in MS Excel (advanced formulas, pivot tables), MS Word, PowerPoint, and MS Outlook
Excellent communication skills (verbal, written, presentation)
Ability to influence and resolve complex regulatory issues
Strong organizational and customer service skills
Ability to prioritize multiple tasks and meet strict deadlines

Comprehensive benefits package focused on health, wellbeing, and financial security
Professional development opportunities

Claims TPA Governance Analyst

Key skills