- 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 roundtables with claims handlers and leadership.
- 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 pressureIf interested, please apply to this job advert or reach out to
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Claims Compliance Officer - Chicago - Oliver James Associates
1 day ago
Description
# Claims Compliance OfficerClaims Compliance OfficerSalary$Up to US$140000 per annumLocationChicago, IL, USAContractPermanentIndustryRisk & ComplianceContactOliveaClaims Compliance OfficerJob Summary / IntroductionThe 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-
Compliance Officer
Only for registered members Chicago, IL
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Compliance Officer
Only for registered members Chicago, IL
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Compliance Officer
Only for registered members Chicago, IL
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Compliance Officer
Only for registered members Chicago
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Compliance Officer
Only for registered members Chicago
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Compliance Officer
Only for registered members Chicago
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Compliance Officer
Full time Only for registered members Chicago
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Compliance Officer
Only for registered members Chicago
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Compliance Officer
Only for registered members Chicago
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Compliance Officer
Only for registered members Chicago, IL
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Compliance Officer
Only for registered members Chicago
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Compliance Officer
Full time Only for registered members Chicago
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Compliance Officer
Full time Only for registered members Chicago
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Compliance Officer
Only for registered members Chicago, IL
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Claims Compliance Officer
Only for registered members Chicago, IL
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Chief Compliance Officer
Only for registered members Chicago, IL
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IDD Compliance Officer
Only for registered members chicago
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Senior Compliance Officer
Only for registered members Chicago, IL
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Compliance Officer, ECRM
Only for registered members Chicago, IL
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Senior Compliance Officer
Only for registered members Chicago, IL
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Chief Compliance Officer
Only for registered members Chicago, IL