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Claims Compliance Analyst Jobs (NOW HIRING)

The MH Group

Claims Compliance Analyst

East Longmeadow, MA · On-site

$60K - $70K/yr

We are seeking a Claims Compliance Analyst to join our client's team! This is a fully remote position with a great company offering fantastic benefits. The Claims Compliance Analyst is responsible ...

Verisk

Compliance Analyst

Jersey City, NJ · On-site

$60K - $75K/yr

... claims handling with analytic and automation tools that streamline workflow, improve claims ... and compliance of every consumer engagement Life Insurance Solutions - offers end-to-end, data ...

Verisk

Compliance Analyst

Jersey City, NJ · Hybrid

... claims handling with analytic and automation tools that streamline workflow, improve claims ... Minimum 1+ years' experience in compliance, audit, risk, or analytics field or equivalent

Puyenpa

Compliance Analyst

Washington, DC · On-site

The Compliance Analyst will evaluate documentation, identify deficiencies, ensure adherence to ... Familiarity with administrative compliance frameworks or claims review processes. * Background in ...

Firstsource

Compliance Analyst

Thousand Oaks, CA · On-site

Position Summary The Compliance Analyst plays a critical role in supporting consumer and commercial ... This position is responsible for reviewing and processing complaints, disputes, fraud claims, and ...

Firstsource

Compliance Analyst

Thousand Oaks, CA · On-site

Position Summary The Compliance Analyst plays a critical role in supporting consumer and commercial ... This position is responsible for reviewing and processing complaints, disputes, fraud claims, and ...

Chubb

ESIS Claims Compliance Specialist, WC

Tampa, FL · On-site

$22 - $30.25/hr

Manage all fines/penalties, including root cause analysis, write-ups, and approval workflows ... Experience with claims, compliance, or regulatory environments (Florida required) Active adjuster ...

Panda Restaurant Group

Risk Compliance Analyst

Rosemead, CA · Hybrid

$72K - $101K/yr

The Risk Compliance Analyst analyzes claims trends to identify broader issues and recommends solutions. This position also serves as the centralized support person to assist the Senior Safety Manager ...

The Children's Center

Compliance Analyst

Detroit, MI

Oversee the dissemination and tabulation of internal audit results (Medicaid Claims, PHQ Compliance ... Produce data analysis, trends, and standard reporting which enables the organization to monitor ...

Chubb

ESIS Claims Compliance Specialist, WC

Fremont, CA · On-site

$78K - $114K/yr

The ESIS Claims Compliance Specialist supports compliance and operational excellence within the ... analysis, account-specific projects, closing projects, and audits. Qualifications * Minimum of five ...

FastTek

Compliance Analyst

Newark, NJ · On-site

Compliance Analyst #1057192 The type of work would be: * Request entry packets from brokers * Save ... other duty/tax claims. Provide drawback and Business Unit management/finance information to ...

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How much do claims compliance analyst jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for claims compliance analyst in the United States is $27.39, according to ZipRecruiter salary data. Most workers in this role earn between $20.19 and $31.49 per hour, depending on experience, location, and employer.

Is compliance analyst a stressful job?

A claims compliance analyst's job involves reviewing and ensuring adherence to regulations in insurance or financial claims, which can be demanding due to strict deadlines and the need for accuracy. The role may involve handling complex cases and requires attention to detail, but stress levels vary depending on workload and organizational support.

What does a claims compliance analyst do?

A Claims Compliance Analyst is responsible for ensuring that insurance claims are processed in accordance with legal, regulatory, and internal company standards. They review claims documentation, conduct audits, and monitor for compliance with applicable laws and policies. Their work helps prevent errors, reduce fraud, and maintain the integrity of the claims process. Additionally, they may assist in training staff on compliance issues and prepare reports for management.

What is the difference between Claims Compliance Analyst vs Claims Auditor?

CriteriaClaims Compliance AnalystClaims Auditor
Required CredentialsCertifications like CPC, CCA often preferredCertifications such as CPC, CCA common
Work EnvironmentOffice setting, insurance companies, healthcare providersOffice environment, insurance firms, third-party audit companies
Employer & Industry UsageInsurance companies, healthcare organizationsInsurance firms, third-party auditing agencies
Common Search & ComparisonYesYes

The Claims Compliance Analyst focuses on ensuring claims adhere to regulations and internal policies, often working proactively to prevent issues. In contrast, Claims Auditors primarily review and verify claims after submission to detect errors or fraud. Both roles require similar certifications and are found within insurance and healthcare industries, but their focus points and timing differ.

What are the key skills and qualifications needed to thrive as a claims compliance analyst?

To thrive as a Claims Compliance Analyst, you need a solid understanding of insurance claims processes, regulatory requirements, and data analysis, often supported by a degree in business, finance, or a related field. Proficiency in claims management systems, regulatory databases, and tools like Excel or compliance software is typically required. Attention to detail, analytical thinking, and strong communication skills help ensure accurate assessments and effective collaboration. These skills and qualities are essential to maintain regulatory compliance, minimize risk, and support organizational integrity in claims handling.

What are some common challenges faced by claims compliance analysts when ensuring regulatory adherence?

Claims Compliance Analysts often encounter challenges such as keeping up with frequently changing insurance regulations and ensuring that claims processes are consistently aligned with both internal policies and external legal requirements. They must regularly audit claims, identify potential compliance risks, and communicate findings to different departments, which requires attention to detail and strong collaboration skills. Managing tight deadlines while balancing multiple ongoing audits can also be demanding, but effective organization and open communication with colleagues help analysts stay on track.
More about Claims Compliance Analyst jobs
What job categories do people searching Claims Compliance Analyst jobs look for? The top searched job categories for Claims Compliance Analyst jobs are:
Claims Compliance Analyst jobs near you
Infographic showing various Claims Compliance Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 11% Part Time, and 4% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $56,974 per year, or $27.4 per hour.

Claims Compliance Analyst

The MH Group

East Longmeadow, MA • On-site

$60K - $70K/yr

Full-time

Re-posted 21 days ago

Job description

Description:

We are seeking a Claims Compliance Analyst to join our client’s team! This is a fully remote position with a great company offering fantastic benefits. The Claims Compliance Analyst is responsible for maintaining a deep knowledge of the claim processes, can process claims, and is expected to comply with internal company policies and procedures. The ideal candidate is responsible for the entire claims process from beginning to end and the implementation, auditing, and execution of compliance activities regarding claims. The Claims Compliance Analyst will work collaboratively with different departments to assess compliance risks, controls, and implement new regulations that affect the claims team. In this role, you will…

  • Navigate different claims systems.
  • Work within systems like RegEd to review assigned tasks and implement new laws, rules, and regulations.
  • Work cross-departmentally to understand and implement new and/or existing regulations utilizing systems such as RegEd.
  • Maintain an in-depth understanding of the claim adjudication process.
  • Process claims by all regulations in a timely and accurate manner, including analyzing the submitted medical treatment and investigating the coverage terms.
  • Maintain a strong understanding of state and federal health insurance regulations and mandates.
  • Strong knowledge of products/systems, and a subject matter expert (SME).
  • Create, carry out, and audit compliance items linked to claims, including risk assessment, testing, and monitoring of important laws & regulations, rules & processes, help with exam preparation, issue reporting & escalation, training materials, and remedial measures.
  • Assist in market conduct exams by reviewing claim-related tasks.
  • Create and implement procedures for regulatory items impacting claims that require special handling.
  • Regularly partake in compliance-related meetings.
  • Review all claim-related compliance reports to ensure accuracy.
  • Scrub pay-related reports to accurately determine the clean claim date and proper penalties/interest.
  • Handle claim adjustments related to regulatory requirements.
  • Perform other duties as assigned.


Requirements:

Our ideal candidate will have…

  • A minimum of 5 years of experience in health insurance claim processing is required.
  • Capacity to plan, carry out, and document compliance self-monitoring initiatives.
  • Ability to comprehend complex laws/regulations.
  • Ability to assess, prioritize, and communicate claims risk.
  • Ability to understand complex problems, identify root causes, and remain goal-oriented.
  • Strong analytical skills, with the ability to effectively identify, communicate, and address potential issues.
  • Strong written/verbal communication, interpersonal, and presentation skills.
  • Ability to work in a fast-paced environment, prioritize multiple assignments simultaneously, think quickly, meet deadlines, and adapt to various situations.
  • Ability to work independently, with peers, and with departments in business areas at all levels of the organization.
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About MH Group

Sourced by ZipRecruiter

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

East Longmeadow, MA, US

Year founded

2013

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