Claims Compliance Officer

# Claims Compliance Officer Claims Compliance Officer Salary$Up to US $140000 per annum

Location

Chicago, IL, USA Contract Permanent Industry Risk  & Compliance---Contact Olivea Kupiec
** Claims Compliance Officer
** Job Summary / Introduction The Claims Compliance Officer is a senior, highly technical role supporting U.S. insurance claims operations in a complex, multi-jurisdictional environment. This position plays a critical role in strengthening claims governance, regulatory oversight, and compliance controls across all U.S. states and applicable federal requirements.

The role acts as a subject matter expert for claims compliance and regulatory risk, partnering closely with claims leadership, legal, technical claims teams, training, QA, SIU, and technology stakeholders. The position supports both internal claims teams and third-party administrators and is essential to scaling a compliant claims operation in a growing organization.

Detailed

Job Description
* Own and support claims compliance oversight across all U.S. jurisdictions, including state and federal requirements.
* Monitor, interpret, and apply legislative, regulatory, and legal developments impacting claims handling.
* Translate regulatory change into operational guidance, policies, procedures, controls, and training materials.
* Maintain enterprise claims compliance documentation and jurisdiction-specific requirements.
* Design, implement, and manage controls related to claims obligations, including Medicare Secondary Payer, Section 111 reporting, OFAC, market conduct, and other federal protocols.
* Partner with claims technical, legal, IT, QA, SIU, licensing, and training teams to design compliant workflows and processes.
* Lead and support regulatory inquiries, complaints, audits, and market conduct examinations.
* Review large volumes of claim files and develop defensible responses to regulatory findings.
* Develop and execute compliance monitoring programs, audits, dashboards, and effectiveness reporting.
* Support claims system enhancements and compliance-related technology integrations.
* Participate in and lead training sessions and round tables with claims handlers and leadership.

Skills & Experience
* 10+ years of experience in insurance claims compliance, insurance regulation, or legal/claims operations.
* Deep knowledge of claims handling regulations, market conduct standards, and federal claims requirements.
* Demonstrated experience operating in a true 50-state claims environment with jurisdictional variability.
* Strong understanding of Medicare lien processes and settlement requirements.
* Experience supporting regulatory audits, examinations, and enforcement actions.
* Ability to analyze claim files, assess compliance findings, and construct clear legal or regulatory arguments.
* Strong research, writing, analytical, and stakeholder communication skills.
* Proven ability to work independently, manage competing priorities, and perform under pressure

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