Insurance (Compliance)

 

• Promptly negotiated settlements as appropriate, ensuring that such settlements reflected the verified claimant losses while also protecting the insurer from invalid claims.

 

• Developed and implemented an enterprise-wide claims compliance program, to establish base compliance standards, investigate identified compliance issues, and then to implement effective legal controls to monitor and prevent future compliance deficiencies.

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• Developed and implemented a claims compliance risk management strategy.

 

• Managed enterprise awareness of regulatory changes through a proprietary matrix, including monitoring state and federal regulatory changes across all jurisdictions, and also in some foreign jurisdictions, for all product lines.

 

• Coordinated with regulatory affairs professionals, subject matter experts (SMEs) and external regulatory counsel to respond to and address the results of regulatory audits, complaints and market conduct exam activity.

 

• Validated the legal aspects of the claims system, to ensure adherence to state and federal regulations, and the accuracy of payments.

 

• Conducted trending analysis, using data analytics and other reporting mechanisms, to identify potential compliance issues.

 

• Worked with claims managers to establish workflows, job tools, policies and procedures to address identified issues.

 

• Spearheaded investigations of claims related compliance issues or breaches.

 

• Audited and analyzed claims to ensure that the pricing was accurate and in accordance with the applicable policy.

 

• Tracked, coordinated and reported to management on internal compliance audit results and identified issues.

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• Identified gaps in legal controls and the execution of regulatory requirements, and then made recommendations to resolve the issues.

 

• Analyzed claims history for issues affecting claims payments, varying policy interpretations and processing errors.

 

• Evaluated and audited system fee schedules to identify and resolve system issues.

 

• Communicated issues to the applicable internal departments to determine the causes for identified issues, and then worked collaboratively to formulate solutions.

 

• Documented inquiries and reported legal issues, conducted internal audits and reviewed the results to identify the causes of such issues.

 

• Provided formal responses to inquiries from administrative agencies, and recommended actions to remedy any deficiencies.

 

• Prepared forms and other materials to assist with compliance initiatives.

 

• Conducted technical surveys of clients to evaluate loss potential and adequacy of existing control programs, and then documented the results for executive management.

 

• Administered the legal aspects of the rating and underwriting processes, including loss history reports, credit checks, outside inspections and loss control.

 

• Supported the development of underwriting and training tools.

 

• Reviewed new and renewal policy applications for acceptance, confidential information exposure, coverage, intellectual property infringement, negligence, privacy breach, product and service defect, risk selections and price.

 

• Assessed organizational risks, mitigation of risks, implementation of successful resolutions, and comprehensive cost assessments, periodic reports and presentations to management regarding existing and potential litigations.

 

• Implemented and monitored the legal aspects of total loss control programs for complex accounts.

 

• Formulated legal strategies for loss mitigation, and analyzed loss information to determine future loss trends and required legal controls.

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• Managed compliance specialists and SMEs, and addressed federal and state regulatory compliance requirements for all product lines.

 

• Provided guidance for the preparation and filing of financial and regulatory reports with governmental insurance departments.

 

• Developed strategic and operational plans to improve efficiency, meet department goals, and maintain corporate authority to do business in all jurisdictions.

 

• Developed and implemented a regulatory compliance change management program, monitoring all relevant state and Federal laws, regulations and rules.

 

• Researched laws and regulations in response to internal inquiries or perceived enterprise needs regarding regulatory compliance.

 

• Monitored changes in laws and regulations for application to company lines, communicates changes and made recommendations to affected departments.

 

• Drafted and reviewed responses to insurance department complaints and inquiries.

 

• Extensive authoring and review of corporate policies relating to records management and retention, servicing protocols, compliance management systems (CMS), board management, risk assessment, loan origination guidelines, audit functions, vendor management and consumer interaction guidelines.

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Last updated 200722_1717