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Years of Experience
Date Last Verified
General Counsel & Compliance Officer Duties: Reviews and disseminates all state and federal regulations and guidance and provides legal advice and interpretation regarding state and federal requirements. Participates in the definition and development of corporate policies, procedures and programs and provide continuing counsel and guidance on legal matters and on legal implications of all matters. Leads the CGHC Appeals & Grievance Committee. Serves as key legal advisor on all major business transactions. Negotiates, reviews and executes corporate legal documents and contracts including vendor contracts, management agreements, and contracts with providers. Oversees the form and other annual filings; approves all internal communications; obtains appropriate regulatory approvals related to business transactions. Represents the organization in relations with state and federal bureaus, departments and agencies including the Office of the Commissioner of Insurance (OCI). Develops, initiates, maintains, and revises policies and procedures for the general company operations as well as for the Compliance Program and its related activities. Provides reports on a regular basis, and as directed or requested, to keep the Corporate Compliance Committee of the Board and the Executive Team informed of the operation and progress of compliance efforts. Provides leadership for compliance with federal and state law; exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct. Works with outside audits on compliance audits. Develops and oversees a compliance performance audit system; responds to all compliance questions or concerns. Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future. Develops an effective compliance education program, including appropriate introductory education for new staff as well as annual and ongoing education for all staff. All other duties and assignments as requested.
Qualification and Experience
Requirements: JD Degree required 1-3 years' experience within a health insurance environment or a within law firm specializing in health- related law; knowledge of the Affordable Care Act. Expertise in legal research, compliance requirements and knowledge of laws and regulations imposed on health insurance companies, such as OCI regulations, CMS/HHS and HIPAA rules required. Ability to communicate effectively with a variety of contacts, including outside attorneys, auditors and regulatory bodies. Experience working on matters of corporate governance and with a Board of Directors. Experience in negotiating vendor contracts, conducting due diligence, and closings for business deals. Excellent writing ability, analytical and computer skills, and the ability to communicate effectively. Ability to pay precise attention to detail; strong organizational skills. Strong verbal, written, interpersonal and public meeting communications skills.
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