Job Title: IFG - Senior Compliance Professional
Job Responsibilities:
The Senior Compliance Professional at the company is tasked with ensuring adherence to Health Plan contracts and governmental requirements, particularly focusing on Medicare Advantage within the Field Marketing Organization (FMO). This involves handling moderately complex to complex issues requiring in-depth evaluation of variable factors. Key responsibilities include:
- Monitoring and overseeing insurance agents and agencies to ensure compliance with policy, procedures, and federal and state regulations.
- Researching and investigating allegations of agent/agency misconduct and determining appropriate corrective actions.
- Analyzing and identifying trends in agent-related complaints, including CTMs, and implementing measures to reduce such complaints.
- Demonstrating a thorough understanding of Medicare regulations and effectively applying these regulations in daily tasks.
- Responding to interdepartmental inquiries and coordinating with partner agents and agencies.
- Making decisions on complex issues with minimal direction and handling sensitive work urgently.
- Monitoring changes in Medicare regulations, providing insights and recommendations to leadership and internal teams.
- Conducting compliance audits and assessments to identify risks and areas for improvement, implementing corrective actions as necessary.
- Collaborating with cross-functional teams like marketing, operations, and sales to integrate compliance into all Medicare Advantage initiatives.
- Developing and delivering training on compliance requirements, best practices, and regulatory changes.
- Reviewing marketing materials and communications for compliance with CMS guidelines and company policies.
- Preparing and maintaining documentation for compliance activities, including reports, training materials, and audit findings.
- Participating in the development of policies and procedures to enhance compliance operations and risk management.
Education and Experience Information:
Required Qualifications:
- This is a limited-term position expected to last 3-9 months, with the exact duration to be determined.
- Minimum of 3 years of experience in compliance within the insurance industry, with a focus on Medicare Advantage.
- Strong understanding of Medicare regulations, CMS guidelines, and compliance best practices.
- Excellent analytical skills to assess complex regulatory requirements and develop actionable strategies.
- Strong communication and interpersonal skills for effective collaboration with various stakeholders.
- Proven ability to work independently and manage multiple priorities in a fast-paced environment.
- Minimum of 1 year of audit or consulting experience.
- Experience with metric monitoring and reporting.
Preferred Qualifications:
- Bachelor’s degree in Business, Finance, Law, Healthcare Administration, or a related field.
- Advanced degree.
- Compliance certification, ., CHC.
Salary Information:
The compensation range for this full-time position (40 hours per week) is estimated to be between $86,300 and $118,700 per year. The pay range may vary based on geographic location, job-related skills, knowledge, experience, education, certifications, etc.
Description of Benefits:
The company offers benefits for limited-term, variable schedule, and per diem associates designed to support whole-person well-being. These benefits include paid time off, a 401(k) retirement savings plan, an employee assistance program, and business travel and accident insurance.
