Claims Compliance Coordinator

Job Description
Looking for a career in a world class organization? Consider an opportunity with Nautilus Insurance Group. Nautilus Insurance Group is a member of W.R. Berkley Corp., a Fortune 500 company. We specialize in providing excess and surplus lines commercial property and casualty insurance coverage.

We currently have an opening in our Claims Department for a Compliance Coordinator. The Compliance Coordinator ensures compliance with a variety of statutory requirements associated with claims handling, the most significant of which is MMSEA (Medicare, Medicaid, SCHIP Extension Act) Section 111.


The Compliance Coordinator will:

- Manage MMSEA compliance data including preparing and submitting queries and reports and analyzing result.

- Review monthly MMSEA Error Report, determining changes and updating information.

- Assist Examiners with management of CMS data, reviewing claims, communicating with claimants and maintaining current data (e.g. CMS beneficiary, TPOC, ICD-9 codes, etc).

- Manage MSPRC (Medicare Secondary Payer Recovery Contractor) lien information.

- Acquire and communicate MMSEA information (by participating in conference calls, reviewing industry bulletins and seeking out other sources for awareness of impending regulatory changes.

- Collaborate with Claims and Regulatory personnel to interpret statutory requirements, identify and implement necessary workflow changes and assist with staff training as needed.

- Manage the administration of other compliance information, including but not limited to, the Child Support Lien Network, Massachusetts Payment Intercept Program, National Motor Vehicle Title Information System, Sarbanes-Oxley, etc.

- Update workflow documents as needed at least quarterly, as well as update FAQ document.

- Facilitate the Claims Medicare Focus Group meetings and related projects.

- Review monthly MMSEA Processed Claim Notification and MMSEA Query Response File Notifications.

- Attend seminars, webinars and other training events as appropriate.


Associate's or equivalent of education and experience is required.

A minimum of three years experience in a business or related field is necessary.

Functional knowledge of insurance claims terminology is essential.
Previous experience with an insurance carrier and in a paperless environment is beneficial.

All candidates will possess superior analytical, written and verbal communication skills and have intermediate to advanced skills in Excel and PowerPoint.

Nautilus believes our employees are our greatest asset. We foster an environment of accountability, teamwork and integrity. Our motivated employees have built an impeccable reputation for our firm serving the Excess and Surplus Lines industry. Nautilus
Insurance offers an excellent benefits package including comprehensive medical insurance, dental, life/AD&D, both short- and long-term disability insurance and a great 401(k)/Profit Sharing plan. Nautilus promotes a healthy lifestyle for our employees by providing an onsite fitness facility and a variety of wellness programs.


Nautilus Insurance Group, LLC

Job Code

State or Province


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