Compliance & Licensing Specialist (TPA/Insurance & Claims Adjudication Focus)

Zuplon

Website: zuplon.com
Job details:

Job Title: Compliance & Licensing Specialist (TPA/Insurance & Claims Adjudication Focus)

Location: Remote (India-based), with significant overlap with U.S. business hours.

Responsibilities:

* Oversee all TPA licensing applications, renewals, and compliance obligations across multiple U.S. states (e.g., TX, IL, MI, PA).

* Prepare, submit, and track regulatory filings (license applications, renewals, bonds, etc.).

* Ensure compliance with regulatory requirements related to claims adjudication processes, including documentation standards and operational guidelines.

* Monitor deadlines for compliance across jurisdictions and proactively coordinate with leadership on any required actions.

* Maintain detailed records of licenses, filings, claims adjudication compliance activities, and regulatory documentation.

* Serve as the internal expert on evolving state regulations, advising on updates or changes impacting licensing and claims adjudication operations.

* Collaborate closely with leadership and other team members, ensuring clear communication on ongoing compliance and claims-related projects.

Qualifications:

* Proven experience in U.S. insurance licensing, TPA regulatory compliance, claims adjudication, or related operational compliance functions.

* Knowledge of multi-state licensing processes, claims handling standards, and familiarity with U.S. regulatory bodies.

* Strong organizational and time-management skills; capable of handling multiple state deadlines and compliance workflows.

* Excellent communication skills, comfortable working cross-border and aligning with U.S.-based leadership.

* A proactive mindset—anticipating compliance and claims-related requirements and resolving issues independently.

* Flexibility to grow with the role (potential future expansion into broader compliance, regulatory, or claims operations areas).

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