Claims Compliance QA Analyst Lead; Boston, MA
Listed on 2026-01-12
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Healthcare
Claims Compliance QA Analyst Lead (Boston, MA)
We are currently recruiting for a Claims Compliance QA Analyst Lead in Boston, MA (financial district in-office 2 days required). This is a great opportunity to join a growing team and play a critical role in regulatory risk. The Senior Analyst will translate risk into actionable strategy and build sustainable compliance practices. The ideal candidate will be experienced in insurance claims regulations, Medicare protocol and a compliance professional or attorney.
Must have extensive knowledge of insurance claims regulations, processes, and technology. 120K – 140K Base + Bonus + Benefits Package
- Lead US Claims response to regulatory inquiries and complaints
- Manage and maintain 50-state claims database
- Monitor legislation, DOI bulletins, court reporters/decisions, and statutory changes; manage backlog and implement targeted compliance training
- Deliver training and legal support to internal teams and vendors
- Develop audit programs and dashboards to monitor compliance effectiveness
- Oversee/support technology-related compliance integrations
- Provide executive reporting, trends analysis, and regulatory insights
- Develop and own controls related to Medicare, OFAC, Child Support Lien Network, and other federal protocols
- Partner with Claims Technical, US Legal, and IT to design controls and workflows aligned with regulatory requirements
- Degree in law, risk management, or a related field; required - J.D. highly desired
- 10+ years of experience in claims compliance, insurance regulation, or legal operations
- Advanced insurance compliance certifications a plus (CPCU, CIPP, CAMS, CRCM, or similar) Scrum/PMP a plus but not required
- Deep understanding of claims handling regulations and Medicare protocols
- Experience with multiple lines of business in a 50-state claims environment
- Knowledge of Medicare Secondary Payer requirements and Section 111 reporting
- Strong research and policy writing skills
- Excellent collaboration, project management, and problem-solving skills
- Experience with regulatory audit preparation and response
Local candidates only. Must be in a commutable range to the financial district in Boston, MA. Hybrid - in-office 2 days. To apply email resume to p
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