Complaint Resolution Analyst

Job Summary

The Complaint Resolution Analyst supports the Company's agent monitoring, anti-fraud, and consumer complaint programs. Responsibilities include investigating and responding to consumer complaints, supporting internal and external fraud referrals and investigations, performing agent monitoring, and managing regulatory inquiries from state Departments of Insurance. This role also involves assisting in reporting, contributing to policy and procedure development, and making recommendations for process improvements to reduce risk and enhance customer experience.

This position reports to the Compliance Manager and works closely with members of the Legal, Risk, Operations, and Sales teams.

Duties & Responsibilities

• Generally: Effectively communicate and provide agents, Company personnel, and third-party administrators with support and education on the Company’s agent monitoring, anti-fraud and complaint programs. Conduct outreach to agents, agencies and IMOs to discuss transactions pending review, explain the nature of any deficiency, and obtain updated information. Engage compliance management and corporate counsel regarding unusual cases or sales practice, fraud concerns, or complaint matters. Maintain strong working knowledge of the Company’s products, administrative systems and procedures. Make recommendations for process improvements based on investigation outcomes to prevent future complaints and reduce risk
• Consumer Complaint Resolution: Investigate and review customer, agent, and Department of Insurance complaints as assigned by management. Collect and analyze relevant documentation, transactions, and correspondence to understand the nature and details of each complaint. Draft written responses to complaints that are accurate, timely, and compliant with regulatory standards. Manage the complaint database for reporting and tracking purposes and archive relevant complaint documents. Assist in preparing management reports related to consumer complaint trends and outcomes. Report trending issues identified in the sales or administrative process to management.
• Agent Monitoring: Perform functions under the Company’s Red Flag system relative to complaints for identifying potential issues. Support all screening of producers seeking appointment. Perform electronic monitoring of agents as directed. Compile and respond to state insurance regulator inquiries regarding agents or fraud investigations. Assist with the continuous improvement of the Company’s Agent Monitoring Program
• Anti-Fraud: Perform investigative duties on potentially fraudulent activity by reviewing documents and files, developing investigative plan of action, and reporting relevant findings to management in a timely manner. Suggest and perform appropriate actions to resolve the circumstances and mitigate risk to the Company (producer terminations, dismissals, and probationary actions). Assist with ad-hoc investigative requests as directed by management

Supervisory Responsibilities:  This role does not have formal people leadership responsibilities but may provide guidance, mentorship, or subject matter expertise to others.

Knowledge, Skills & Abilities

• Strong written and verbal communication skills
• Strong organizational skills and attention to detail
• Strong analytical skills and aptitude for detailed work
• Ability to manage multiple priorities in a fast-paced environment
• Working knowledge of insurance industry rules and regulations

Minimum Qualifications

• Bachelor's Degree
• 2+ year of relevant experience in an insurance compliance, investigative, or operational role

Preferred Qualifications

• Insurance or financial industry designations, or coursework toward compliance, ethical, or anti-fraud designations (e.g., LOMA FLMI, AIRC, CFE)
• Paralegal certificate or legal support background is a plus

Other Requirements

• This position primarily involves sedentary work, requiring long periods of sitting, regular use of a computer, and occasional standing or walking, with reasonable accommodations available.
• Perform other functions, duties and projects as assigned
• Regular and punctual attendance

Ability to travel up to:  10% of the time

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