AVP, Claims Compliance & Regulatory

Overview

The Assistant Vice President (AVP) of Claims Compliance position involves developing, implementing, and overseeing compliance programs to mitigate risks and ensure claims processes and procedures adhere to legal and regulatory standards. The position monitors regulatory changes, audits claims for compliance, and works closely with legal and operational teams to address any issues that may arise. Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of the AmTrust organization.

Responsibilities

• Lead and mentor a team of compliance professionals, fostering a culture of integrity, accountability, and continuous improvement.
• Conducting regular audits/testing related to Sarbanes-Oxley (SOX), Medicare reporting, state/bureau reporting (NCCI, EDI, etc.), financial controls, state regulatory requirements, market conduct studies, and other audits deemed necessary to ensure the claims department is in full compliance with all relevant laws and regulations.
• Develop KPIs and metrics related to compliance & regulatory results.
• Analyze and identify adverse trends in compliance & regulatory results and partner with Claims leadership to develop improvement/corrective action plans to improve compliance standards.
• Develop and maintain relationships with external stakeholders, including regulators, industry associations, and legal counsel, to stay informed about industry standards and best practices.
• Serve as the primary point of contact for regulatory agencies, audits, and inquiries related to claims compliance.
• Provide guidance and training to claims staff on compliance-related matters, including regulatory updates, best practices, and risk mitigation strategies
• Prepare and present reports on claims compliance activities, findings, and recommendations to senior management and relevant stakeholders Leads compliance & regulatory related IT-ideation efforts in partnership with Claims Field Operations to ensure efficiency in compliance processes.
• Acts as the subject matter expert for the Claims organization in all projects and initiatives to ensure understanding and compliance with applicable state, federal and other regulatory requirements.
• Collaborate with legal, risk management, and claims teams to interpret regulatory requirements and implement compliant processes and procedures.
• Ensure that all claims processes are compliant with relevant laws and regulations
• Keeps current with market trends and demands.
• Performs other functionally related duties as assigned.
  
  

Qualifications

• Minimum of 10 years of relevant work experience in claims management and/or insurance regulatory/compliance including experience in supervisory or managerial roles, demonstrating progressively increasing levels of responsibility and achievement.
• Minimum of 3 years serving in a compliance or claims operations function driving key initiatives, monitoring operational metrics, evaluating process efficiencies, and implementing corrective actions when needed.
• Bachelor's degree in business, insurance, risk management, or related field; advanced degree or professional certification (e.g., law degree, CPCU) preferred
• Proven track record of leadership experience in compliance or claims management, preferably in a shared services environment within the insurance or financial services industry.
• Experience working with Departments of Insurance and other regulatory bodies preferred.
• Familiar with industry-related regulatory software products (i.e. MetricStream, Bwise, Wolters Kluwer) or auditing platforms (i.e. C2P, TeamThink).
• Experience with analyzing state and local laws to instrument solutions to operationalize compliance preferred.
  
  

This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust has the right to revise this job description at any time.

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.