Resp & Qualifications
PRINCIPAL ACCOUNTABILITIES: Under the direction of the Manager, Regulatory Compliance SBU, the principle duties and responsibilities include, but are not limited to, the following:
Minimum of 3+ years working experience in health insurance industry, managed care and government programs, health insurance compliance programs, or related fields. A Bachelor’s degree in Business Administration, Healthcare Compliance or related field is required. Experience in project management, business process analysis, work flow, and task analysis; The ability to read and interpret insurance laws, regulations and policies is a must. Experience in state, federal regulatory oversight is required.
Travel is necessary to coordinate audit primarily in both the DC and MD offices and other sites as required.
The Incumbent must display leadership qualities, functional expertise, and business perspective; Considerable judgment, tact, initiative, accuracy and trustworthiness; Excellent interpersonal skills with ability to build consensus and agreement and bring resolution to contentious issues and entrenched interests. This position also requires the ability to present and discuss regulatory compliance goals in a way that establishes rapport, persuades others, and gains commitment, the ability to research complex issues, interpret regulations and regulatory rules/guidance, and exhibit sound judgment in determining a recommendation or solution to a problem, demonstrated ability to lead problem-solving discussions, flexibility and the ability to adapt to shifting priorities, to work independently as well as part of a team .
The successful candidate will possess strong organizational, coordination skills and interpersonal skills for facilitating Compliance audits, the ability to gather and analyze data and generate reports, knowledge of local systems (such as Facets and surround systems , etc.) and experience with hardware and software required in order to understand how they interface with the compliance regulatory statutes
Must be experienced and proficient with Word, Advanced Excel and database management and related software applications; Excellent oral and written communications; able to communicate and make presentation to all levels of management and associates at all levels throughout the Company; must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Knowledge of organization and operations of the business areas being supported such as CareFirst Systems and experience in Claims, Enrollment and Billing and Service. An understanding of legal requirements and expectations for health insurance operations.
Department: Small Medium - Service Business Unit - Regulatory Compliance
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 6/9/2018
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly to Federal health care programs.
The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
The employee is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship