Compliance Specialist

Responsibilities

• Supports internal customers by assisting them to understand regulatory and other requirements, implement compliant solutions and establish adequate monitoring mechanisms.
• Receives, logs, researches, analyzes, and responds to compliance inquiries and concerns that are related to regulatory and other requirements and guidance, as well as other compliance issues.
• Administers the Incident Reporting and Corrective Action process to ensure that compliance issues are identified, addressed, and resolved on a timely basis, using an approach that prevents future reoccurrence of similar issues.
• Participates in projects or committees aimed at implementing operational, technological, and other changes to achieve or maintain compliance with regulatory and other requirements.
• Conducts oversight activities of First-tier, Downstream, and Related Entities (FDRs), Delegated Downstream Entities (DDEs) and/or CHIP subcontractors, as applicable.
• Develops, maintains, and oversees compliance monitoring activities and strategies.
• Provides support during internal and external audits, as appropriate, and monitors the completion of corrective action plans.
• Reviews, analyzes and evaluates regulations and guidance to determine its impact and affected business areas.
• Prepares, coordinates and/or submits required regulatory filings, attestations or reports.
• Develops and maintains internal departmental policies and procedures and provides recommendations to business areas in their development and implementation of their own policies and procedures.
• Administers or supports processes owned by the department such as Corporate Policy Administration, Conflict of Interest Disclosures, Compliance Training, Regulatory Intake, Compliance Monitoring and Exclusion Screening, among others.
• Performs other tasks as assigned by management, the Compliance Officer or the Chief Compliance Officer.

Requirements

• 3 years' experience in health insurance compliance, auditing, healthcare or related field (Medicare Advantage, Affordable Care Act and/or CHIP, as applicable).
• Experience interacting with regulators preferred (CMS, PID, DHS, as applicable).
• Relevant audit and/or operational experience preferred.
• Strong analytical, critical thinking and problem-solving skills.
• Strong written and verbal communication skills with all levels.
• Attentive to detail and nuances.
• Proficient use of a variety of computer applications, i. e., Excel and Power Point.
• Commitment to delivering high quality work products.
• Commitment to ethics, integrity and compliance.
• Driven to learn, understand, and accomplish.
• Ability to effectively collaborate cross-functional at all levels.
• Ability to work independently, effectively handle changing priorities, and know when to request input from management.
• Ability to persuade and negotiate to resolve differences with skill and understanding.
• Ability to effectively manage multiple projects and/or tasks in a timely and efficient manner.
• Ability to discreetly handle highly confidential information and issues.
• Ability to review, understand, analyze, and apply laws and regulations to specific facts and situations, e. g. those impacting Medicare Advantage, Affordable Care Act and CHIP, as well as those impacting non-government programs, as applicable.
• ATS Optimization Keywords

Below are skills and terms extracted directly from this job posting to improve Applicant Tracking System (ATS) visibility.

This feature helps candidates tailor their applications more effectively.

• Hard Skills
• health insurance compliance
• auditing
• regulatory filings
• compliance monitoring
• incident reporting
• corrective action
• policy administration
• conflict of interest disclosures
• compliance training
• exclusion screening
• Soft Skills
• analytical skills
• critical thinking
• problem-solving
• written communication
• verbal communication
• attention to detail
• collaboration
• independence
• persuasion
• project management
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