Claims Compliance Specialist

Overview:

If you're looking for the stability of a profitable, growing company with the entrepreneurial spirit of a startup, we're hiring. SageSure, a leader in catastrophe-exposed Property Insurance, is seeking a Claims Compliance Specialist to support the continued growth and operational excellence of our Claims team.

In this role, you'll oversee the adjuster licensing process across multiple jurisdictions and lead the complaint handling program to ensure timely, compliant, and customer-focused outcomes. This position is ideal for someone who thrives in ambiguity and enjoys building and scaling processes in a growing organization. You'll be instrumental in evolving our compliance infrastructure by driving process improvements and transforming manual workflows into streamlined automated solutions.

As the SageSure Claims team continues to grow, you'll be an integral part of a dynamic and forward-thinking insurtech—helping to shape how compliance is embedded into the very fabric of our Claims operations.

What you'd be doing:

Adjuster Licensing Compliance & Tracking:

• Own and manage the adjuster licensing lifecycle, including initial licensing, renewals, and continuing education across multiple jurisdictions

• Ensure ongoing compliance with all state licensing requirements and proactively identify potential risks or gaps

• Provide regular, data-driven reporting on licensing status, trends, and risks to leadership

• Serve as the primary point of contact for licensing-related inquiries and communicate regulatory updates clearly to stakeholders

• Support oversight of third-party vendors and licensing partners, ensuring adherence to regulatory requirements and internal standards

• Partner with vendors to improve licensing processes, enhance data accuracy, and drive operational efficiency

• Identify opportunities to streamline and automate licensing workflows, reducing manual effort and improving scalability

• Develop and maintain procedural documentation, controls, and monitoring mechanisms to ensure consistency, accuracy, and audit readiness

Regulatory Complaint Management

• Own the end-to-end complaint handling program, ensuring timely, accurate, and compliant resolution of customer complaints

• Oversee complaint tracking, reporting, and trend analysis; identify root causes and drive remediation efforts

• Develop and maintain compliance documentation, including policies, procedures, and training materials

• Present complaint insights, risks, and recommendations to senior leadership with clarity and precision

• Support regulatory complaint inquiries regarding data calls, market conduct exams, and carrier audit activities

• Partner cross-functionally to implement solutions, including process enhancements and automation opportunities, to address recurring complaint drivers

We're looking for someone who has:

• Bachelor's degree required (Business, Risk Management, Finance, or related field preferred)

• 3+ years of experience of state and federal insurance claims regulations, including licensing requirements, complaint requirements, claims handling procedures, and compliance standards.

• 3+ years of P&C insurance experience

• Proven ability to operate effectively in ambiguous, fast-paced environments with evolving priorities

• Experience building or significantly enhancing compliance or operational processes from the ground up

• Demonstrated success driving process improvement, automation, or transformation initiatives

• Ability to assess, design, and transform processes, including transitioning from manual to automated workflows

• Experience partnering cross-functionally with Operations, Technology, Legal, and Risk teams

• Experience working with or overseeing third-party vendors or TPAs in a regulated environment

• Strong critical thinking skills with the ability to balance regulatory requirements with practical business needs

• Ability to interpret, apply, and communicate complex regulatory requirements clearly to diverse stakeholders

• Strong organizational and time-management skills with the ability to manage multiple priorities and deadlines

• Proficiency in Microsoft Office Suite, Smartsheet, Domo, or similar tools

• Excellent written and verbal communication skills

• High attention to detail and accuracy

• Ability to work both independently and collaboratively

Highly preferred candidates also have:

• 5+ years in P&C insurance experience

• Experience interacting with regulatory agencies and navigating compliance frameworks

• General GRC (Governance Risk and Compliance) Certifications.

• Experience implementing or supporting workflow automation tools or system enhancements

• Experience using licensing and complaint management systems.

• Excellent written and oral communication skills, including identifying stakeholder needs and communicating credibly and effectively with your audience.

• Process or Program Management experience