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Years of Experience
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ProfileCompliance Analyst II The candidate will work with multiple business units on coordination, identification, mitigation, and reporting of cross-functional compliance incidents and risks related to HIPAA compliance, anti-fraud activities, complaint handling, and state and federally regulated obligations for clients and Third Party Administration (TPA) and licensure functions. Will coordinate and perform investigations, and prepare responses for HIPAA privacy and data security incidents, regulatory and consumer complaints, suspected or alleged fraud, designee and legal document review, and other compliance related obligations. Work closely with cross-functional leaders to ensure appropriate resolution, accurate reporting and tracking to meet client specific service level agreements. Perform legal/regulatory or operations research, provide accurate analysis, document clear and concise effective responses and recommendations to firm's leadership. Identify, analyze, and summarize newly enacted legislation and regulation impacting firm's long term care insurance administration. Support TPA licensure and Secretary of State filings, renewals and regulatory reporting. Participate as a compliance subject matter expert during client implementations, audits, and system or process development. Bachelor's degree in business administration, insurance/healthcare administration, or paralegal studies is needed. Should have 5+ years of insurance compliance experience in product filings and working with regulators to resolve complaints and support market conduct examinations. Must have 2+ years Long Term Care Insurance or related experience. Experience with state and federal legal research, and effective analytical skills with quantitative, creative thinking and problem solving skill is needed. Skilled using Microsoft Word, Excel, Outlook and legal research tool is advantageous. AHIP designations as: Long Term Care Professional, HIPAA Professional, Health Care Anti-Fraud Associate, Managed Care Professional is preferred. Healthcare Compliance Accreditations/Certifications is preferred. Training in quality management programs such as Six Sigma or industry equivalent is preferred. Experience with NILS Insource, LexisNexis, or Westlaw is preferred.
Requisition Number: 2447