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Senior Compliance Specialist - Remote

Location: Farmington
Posted on: March 10, 2023

Job Description:

Connecticare is a leading health plan in the state of Connecticut and a subsidiary of EmblemHealth, a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions. WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to reward people for healthy behaviors.To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.
---- Provide support in executing daily operations that maintain the ConnectiCare Commercial Regulatory Compliance Program.
--- Work with the Director and Manager of Compliance to ensure that the commercial lines of business are in compliance with all
applicable federal, state, and local regulations.
--- Monitor compliance; provide recommendations and feedback regarding potential issues and remediations.
--- Perform and/or assist in the performance of regulatory audit activities including preparation activities and follow-up.Principal Accountabilities--- Conduct compliance reviews related to the commercial lines of business.
--- Conduct regulatory compliance monitoring activities for the commercial lines of business (monitor compliance SLA
results and KPIs; CAP implementation; conduct post-implementation audits, etc.).
--- Work with business areas to ensure appropriate corrective actions are taken; maintain documentation, including
investigatory notes and regulatory notifications.
--- Provide regulatory guidance and oversight to business areas related to state and federal regulatory requirements.
--- Assist with preparation for and coordination of external regulatory audits: market conduct exams, targeted market
conduct exams, and market conduct annual statement (MCAS) filings.
--- Coordinate responses to regulatory reports and requests.
--- Conduct other compliance activities and projects as assigned or required.Education, Training, Licenses, Certifications--- Bachelor's degree required, preferably in health care or business-related field.Relevant Work Experience, Knowledge, Skills, and Abilities--- 4 - 6+ years of experience in health insurance operations and/or compliance. (R)
--- Audit experience a plus. (P)
--- Ability to interpret laws and regulations. (R)
--- Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience. (R)
--- Demonstrated ability to successfully manage several complex projects simultaneously. (R)
--- Ability to work independently and as part of a team. (R)
--- Ability to work with internal personnel at all levels and in all areas of the Organization to achieve success. (R)
--- Strong organizational, analytical, project management and problem-solving skills. (R)
--- Proficient in use of Microsoft Office (Word, Excel and PowerPoint; Access is a plus). (R) Additional Information

  • Job Type: Standard
  • Schedule: Full-time
  • Employee Status: Regular
  • Requisition ID: 1000000864
  • Hiring Range: $63,000-$110,000 Pay DisclosureA good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case's facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.

Keywords: CONNECTI CARE, Inc, Farmington , Senior Compliance Specialist - Remote, Other , Farmington, New Mexico

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