Claims Compliance Specialist

Role Overview

• Oversee the adjuster licensing process across multiple jurisdictions and lead the complaint handling program to ensure timely, compliant, and customer-focused outcomes.
• Own and manage the adjuster licensing lifecycle, including initial licensing, renewals, and continuing education across multiple jurisdictions.
• Ensure ongoing compliance with all state licensing requirements and proactively identify potential risks or gaps.
• Provide regular, data-driven reporting on licensing status, trends, and risks to leadership.
• Serve as the primary point of contact for licensing-related inquiries and communicate regulatory updates clearly to stakeholders.
• Support oversight of third-party vendors and licensing partners, ensuring adherence to regulatory requirements and internal standards.
• Partner with vendors to improve licensing processes, enhance data accuracy, and drive operational efficiency.
• Identify opportunities to streamline and automate licensing workflows, reducing manual effort and improving scalability.
• Develop and maintain procedural documentation, controls, and monitoring mechanisms to ensure consistency, accuracy, and audit readiness.
• Own the end-to-end complaint handling program, ensuring timely, accurate, and compliant resolution of customer complaints.
• Oversee complaint tracking, reporting, and trend analysis; identify root causes and drive remediation efforts.
• Develop and maintain compliance documentation, including policies, procedures, and training materials.
• Present complaint insights, risks, and recommendations to senior leadership with clarity and precision.
• Support regulatory complaint inquiries regarding data calls, market conduct exams, and carrier audit activities.
• Partner cross-functionally to implement solutions, including process enhancements and automation opportunities, to address recurring complaint drivers.

Requirements

• Bachelor’s degree required (Business, Risk Management, Finance, or related field preferred)
• 3+ years of experience of state and federal insurance claims regulations, including licensing requirements, complaint requirements, claims handling procedures, and compliance standards.
• 3+ years of P&C insurance experience
• Proven ability to operate effectively in ambiguous, fast-paced environments with evolving priorities
• Experience building or significantly enhancing compliance or operational processes from the ground up
• Demonstrated success driving process improvement, automation, or transformation initiatives
• Ability to assess, design, and transform processes, including transitioning from manual to automated workflows
• Experience partnering cross-functionally with Operations, Technology, Legal, and Risk teams
• Experience working with or overseeing third-party vendors or TPAs in a regulated environment
• Strong critical thinking skills with the ability to balance regulatory requirements with practical business needs
• Ability to interpret, apply, and communicate complex regulatory requirements clearly to diverse stakeholders
• Strong organizational and time-management skills with the ability to manage multiple priorities and deadlines
• Proficiency in Microsoft Office Suite, Smartsheet, Domo, or similar tools
• Excellent written and verbal communication skills
• High attention to detail and accuracy
• Ability to work both independently and collaboratively.

Benefits

• Health insurance
• 401(k) matching
• Professional development opportunities