Participates in and supports companywide corporate ethics and compliance programs, the Trust Program, and the ongoing review and approval of all marketing materials.
- Performs comprehensive, complex regulatory analyses, including the review, summarization and dissemination of key regulatory updates and changes.
- Drives policy and procedure process, including the design, review, cataloging, dissemination and annual updating of corporate policies and procedures.
- Coordinates review and investigation of Trust Program reports.
- Coordinates site visits by Federal and State regulators.
- Develops regulatory process flows, including the documentation of departmental processes, report generation, and process improvement
- Provides project leadership for compliance-related audits, including the review of departmental documents, interview of departmental staff, summarizing results and implementing recommendations.
- Supports the design, development and implementation of the Regulatory database ensuring all key departmental processes are captured in the database for tracking and trending purposes.
- Supports management of the regulatory communications process ensuring all regulatory communications/updates are received, summarized, catalogued, disseminated and acted upon.
- Coordinates filing of regulatory forms, reports, etc. and provides guidance to other departments in understanding and complying with regulatory requirements.
- Tracks all issues referred to the Regulatory Affairs Department up to and including resolution.
- Represents the health plan at federal, state, and local government meetings.
Candidate Education / Experience:
- BA/BS Degree
- 7 years experience in Managed Care/Health Insurance or a Master's Degree in Business, Public Health, Health Care Administration, or related field.
- State or Federal Managed Care Compliance experience.
- Solid knowledge of Microsoft Outlook, Excel, Word, and Access.