Download App | FOLLOW US ON SOCIAL MEDIA
 Upload Your Resume   Employers / Post Jobs 

Health Care Attorney / Insurance Attorney in League City, TX

American National Insurance Company (ANICO) May 12,2016 Mar 30,2016 Location League City TX
This job is expired...

In-House

Attorney

Health Care

Insurance Coverage

Litigation - Whistleblower - CFTC

5-10 yrs required

Profile

Avp Health & Hipaa Compliance Attorney The candidate would research and respond to inquiries on legal questions regarding Group/Health Operations; identify and protect Company’s recovery rights in third party liability cases and subrogation cases, etc.; administer liens and contract with local counsel when necessary; establish standards and practices to achieve cost effective recovery in such matters; provide general counsel, advise and assist Group/Health Operation department heads on controversial underwriting, eligibility and claim matters; assist these individuals with development, implementation, and maintenance of third party administrator and special service agreements such as preferred provider contracts, prescription card services and reinsurance contracts; research and respond to ERISA appeals and other inquiries relating to the Company’s employee benefit plans; advise and present recommendations to the Benefits Committee concerning such inquiries; periodically report to Group/Health Operations management a summary of regulatory changes, providing impact assessment for affected areas; perform status checks to ensure that any necessary compliance steps are implemented for procedures and products; assist in administering the policy development function for all group/health and MGU products; preparation of policies, trust agreements and other special contracts, certificates, amendments, corrections and revisions; provide oversight to the Group/Health Operation’s handling of consumer and similar complaints received through regulatory agencies and like sources; maintain a log of such complaints and responses; serve on the company’s grievance committee for insurance complaints related to utilization review, managed care or patient’s bill of rights procedures; monitor legislative and regulatory trends to anticipate any needed changes in product design; developing contract language for new products. Responsibilities include coordinating the Company’s responses to marketing or other surveys and assisting the Group/Health Operation’s participation in and responses to market conduct exams or other official inquiries by governmental agencies; provide group/health compliance staffing needs, including training and development, in order to maintain a high degree of skill, knowledge and performance; advising all MGUs regarding questions related to program including premium, claim, administrative, regulatory and legal; coordinating reinsurer approval of actions taken in order to ensure proper reimbursement and limit the company’s liability; assist in the “clean-up” of programs that have entered run-out mode in order to assure proper administration at a cost-effective price; assist in the day-to-day functions associated with the collection of delinquent reinsurance proceeds through the use of arbitration or litigation; gathering requested materials from various departments within Health Operations, working with state examiners on issues identified during examinations and prepare company responses to examiner criticisms; provide guidance and assistance in the identification, implementation and maintenance of the company’s policies and procedures covering the privacy of and access to individually identifiable health information; work with all levels of management to create and head HIPAA Privacy Committee; work with management, legal and other key departments to ensure the company has and maintains appropriate privacy and confidentiality consent forms, authorizations and information notices/materials that properly reflect the company’s privacy practices and other legal requirements; direct the development, implementation and ongoing compliance monitoring of all HIPAA Business Associate/Trading Partner Agreements to ensure that all privacy concerns and requirements are addressed; work with applicable company departments in overseeing an individual’s right to inspect, amend and restrict access to their protected health information when appropriate; establish and administer a process for receiving, documenting, tracking, investigating and resolving consumer and/or governmental complaints concerning the company’s privacy policies and procedures; ensure compliance with privacy practices and consistent application of sanctions for failure to comply for all individuals in the workforce and extended workforce (including HIPAA business associates and trading partners) and done in cooperation with Human Resources and Information Security; initiate, facilitate and promote activities to foster information privacy awareness within the company and affiliates; work with company personnel involved with any aspect of the release of protected health information to ensure full compliance with state and federal privacy regulations as well as company policies and procedures; serve as privacy consultant to all company departments and affiliates; work with Office of Civil Rights, other governmental entities and company officers in compliance reviews and investigations.

Qualification and Experience

The candidate should have Bachelor’s degree; Law degree required with 5-10 years’ experience as an attorney; industry education courses important; fundamental to intermediate grasp of data processing principals and techniques desirable; 6-8 years of experience in insurance management/administration with background/exposure in claims, premium accounting, underwriting, sales, litigation or compliance; requires an understanding of all administrative aspects of group/health insurance and reinsurance products; must be a good communicator and must be able to design policy and contract language, procedures and practices, manage complex litigation and make good business decisions.

Additional info

Req Id: 11004

Company info