Search using our robust engine. Get the recommendations you need to get ahead.
Browse through our expansive list of legal practice areas.
Work where you are or where you would like to be. Find where you will work with LawCrossing.
Use our marketplace to feature your opportunity
Start your search today
Set up your account and manage your company profile on LawCrossing
Look through and compare company profiles
Learn from the legal expert
Discover salaries and the scope of your next job
LawCrossing Works Read Testimonials and Share your Story
Carrot Peelers, Sales, Personality and Your Job Search
In-House
Legal Staff
Health Care
Litigation - Whistleblower - CFTC
Min 3 yrs required
Senior Compliance Specialist The candidate will be responsible for implementing an effective compliance program for the US Individual Segment, tailored to the unique needs of a customer facing business. Working closely with USI IFP Compliance Officer and USI business leaders as well as Enterprise Compliance, Legal, Government Affairs, Vendors and other stakeholders, will provide Compliance and Regulatory oversight and support of ongoing operations, work with operational owners to develop and improve controls, and support new business projects and initiatives. Among other things, will be responsible for ensuring that USI is in compliance with CMS Exchange Regulatory requirements for Qualified Health Plans. As well as enterprise compliance programs including Privacy, Information Protection and Records Management programs. Oversees the day-to-day operations of organization’s Compliance programs. Manages programs, policies, and practices to monitor and ensure compliance with the laws, regulations and rules of federal, state, and self-regulatory organizations. Assesses, prioritizes and manages identified risks. Provides advice / counsel to management on Compliance matters. Acts as a liaison between the organization and regulatory agencies. Develops and oversees internal controls to ensure accuracy, timeliness and quality of work. Recommends proactive measures that will reduce the risk of violations and / or non-compliance. Makes recommendations to improve processes and procedures. Develop the needed policies and procedures for the business, coordinating across US Individual segment to ensure that USI has consistent policies across all business functions. Participates in documenting and communicating programs, policies and procedures. Develops and provides appropriate training programs. Coordinates and conducts investigations of non-compliance or potential violations of corporate policy, applicable laws or regulations. Recommends the appropriate response and actions. Acts as Privacy Steward for US Individual: Ensure implementation of published privacy standards and policies; Provide risk information to support annual privacy risk assessments; Promote awareness, education and compliance with privacy issues; Provide support as needed with questions related to privacy, IP, and PHI issues; Support the Enterprise Privacy Office in any privacy compliance related matters; Ensures department’s record keeping systems are updated and maintained appropriately. Develop and execute a risk-based monitoring and testing program, coordinating with the company Individual Family Plan Business as appropriate. Requests or generates and analyzes management reports to assess unit performance, process flow, customer satisfaction and other business metrics. Prepared for CMS audits and drive satisfactory results to these audits. Monitor and insure correction action plans are developed and executed. Manage report outs to the Risk Management Steering Committee.
Qualification and Experience
Qualifications: Bachelor’s degree preferred with emphasis in law/paralegal or public policy. Compliance certification highly preferred (CCEP/CHC). 3+ years of relevant experience in health care environment highly preferred with a good working knowledge of healthcare business processes. Knowledge of NCQA and strong understanding of rules and regulations. Should have excellent written and verbal communication skills across a variety of audiences. Must have proven track record of project management, including effective leadership and on time execution of the plan. Excellent written and verbal communication skills across a variety of audiences. Proven track record of project management, including effective leadership and on time execution of the plan. Demonstrated attention to detail, ability to compile and analyze regulatory and business information, determine cost/benefit, and provide resolutions or recommendations for process improvement. Ideal candidate will be a self-starter with a willingness to learn new areas of the business and regulatory needs. Highly collaborative individual with ability to influence others and build strong professional relationships.
Ref. 16006515
Sign Up Now