CareFirst Careers

Risk and Regulatory Compliance Manager

Resp & Qualifications

Principal Accountabilities:
This position is responsible for supporting a culture consistent with CareFirst’s mission, values, ethics and Code of Conduct.  Through their day to day actions, this position shall demonstrate and convey risk and compliance adherence principles and practices to encourage adoption and acceptance of those practices.

Under the general direction of the Director of Enterprise Risk Management and Compliance, the incumbent’s accountabilities will include, but are not limited to, the following:

Compliance Program Management
Compliance with Regulations: The incumbent oversees the implementation and management of the Finance Division’s compliance program to ensure compliance and alignment with Federal and State regulatory statutes and BCBSA requirements.   Ensures compliance with Federal and State regulatory rules / guidelines to demonstrate the Finance division’s compliance and mitigates risk of exposure in the event of a conflict between the two.  Regarding compliance-related policies, the Manager will gather and organize applicable insurance laws and regulations (mandates) into a central content repository and ensure that a department policy and procedure exists for each law/regulation.  Continuously analyzes and aligns all functional area Policies and Procedures, SOPs, workflows, and systems and ensures updated and current compliance and alignment with regulations.  Reviews complex business processes, systems, workflows, SOPs and P&Ps to identify, document, and elevate the presence of risks and trends within, that may be non-compliant with contracts and or statutory requirements – all jurisdictions, all products, all processing platforms to include our subsidiaries and vendors. Assists Finance Division management in discharging their responsibilities by identifying and mitigating risks, safeguarding assets, identifying fraudulent activities, complying with laws and regulations directly tied to operational efficiency.  Monitors, assesses, and reports significant matters to senior management.  Keeps abreast of emerging issues and developments that have direct impact on the Finance Division Actively participate in implementation/corrective workgroups to ensure compliance perspective and concerns are addressed through the process.

Audit Management: Develops and manages a comprehensive risk based audit program to effectively test controls and continuously reviews and improves departmental policies and procedures to achieve greater efficiencies and effectiveness.  Reviews internal controls, both manual and automated, and/or management controls in each functional area to remove risk or exposure.  Analyzes controls for strengths and weaknesses and ensures that special focus is allocated to the specific risk areas creating the highest exposure to the Finance Division.  Manages the activities related to reviewing audit findings with stakeholders.  Works with Finance Division management to establish and implement corrective action plan as an outcome of any audit findings and monitors/communicates plan status and risks associated with control deficiencies identified to all stakeholders. 

Business Risk Management Program
Risk Mitigation: The incumbent is responsible for the ongoing maintenance and monitoring of all facets of the corporate insurance program, corporate loss control, safety, and other insurance activities throughout the company.  This includes assessing the company’s catastrophic and non-catastrophic exposures and designing an appropriate corporate insurance portfolio.  Responsible for all program components, including professional liability, general liability, workers’ compensation, motor vehicle liability, property, directors and officer’s liability, employment practices liability, pollution legal liability, fiduciary liability, E-Commerce, fidelity, and surety.  Directs the preparation of underwriting submissions and presents the corporate risk profile to underwriters and the broker as needed. To ensure solid analysis and proper assessment of the markets and options, the incumbent manages the broker relationship and negotiates / evaluates new product offerings.  Oversees the development of the annual corporate insurance budget and ensures correct allocation of premiums among the insured entities. The incumbent will also oversee the loss prevention/loss control services to the company; including directing the design, development and implementation of Corporate Risk Management strategies for incident prevention and claims management programs.

Risk Identification and Assessment: Assists in leading the corporation in the identification, analysis, and quantification of exposures to risk and directs the development of the corporate risk map.  Evaluates new risks created by strategic ventures, new products, vendor relationships, legislative reform, regulatory actions, and judicial proceedings.  Studies the relationship among risks and develops the most effective means to mitigate loss by balancing control and financing tools in degrees appropriate to the risk.  Assists in leading the development of tools necessary to create a culture of educated associates able to execute duties consistent with Company’s enterprise risk management philosophy.  Supports the Enterprise Risk Management program by ensuring that corporate risks are communicated to all business area compliance functions and correlated to their risk mitigation functions.  Foster environment that allows associates to perform real time assessments of projects, initiatives or critical business decisions.  Assists in providing direction and oversight to the Corporate Risk Management Committee and reports to executive management. This will entail ensuring that risks to which the company assets are exposed are identified and measured.  Assesses contract risk and recommends insurance requirements and risk provisions to mitigate risk associated with the contract. 

Reporting and Collaboration
Provide regular investigative, analytic, risk and audit reporting data to all stakeholders.  Frequent interaction and regular collaboration and coordination with all internal areas especially all SBUs, Legal, Corporate Compliance, External Mandates, CAAS (Corporate Audit and Assurance Services), and management at all levels to implement and manage the Finance Division risk management and compliance program.   Develops and maintains relationships with key internal customers (i.e., staff line management, senior executives, etc.) through visibility gained by direct meetings, participation on various corporate committees, actively participate on committees, project teams, and other cross-departmental initiatives.  Liaison with Regulatory Agency Investigators/ Auditors in collaboration with Corporate Compliance during external audits.  Liaison with Corporate Compliance and Divisional Embedded Risk and Compliance teams.  Interface with industry regulators to adopt best practices.  Consistently maintains highly professional written and verbal interaction with all levels of staff within the company and with all members within regulatory departments.  Maintain positive, responsive, respectful relationships with all regulators and stakeholders.  Serves as the subject matter expert for risk management, business processes and related systems as the representative of the Finance Division.

Supervisory Responsibility: This position has direct supervisory responsibility over three Risk and Compliance Analysts and Sr. Analysts; indirect collaborative responsibility with the Risk and Compliance functions throughout the company; acts as a trainer across the company and may serve as a leader for various projects within the Division or across the company.

Qualification Requirements:
Required:

  • •Bachelor’s degree with a focus in Healthcare Compliance, Risk Management, or Finance.
  • Minimum of 5+ years of work experience in risk management, managed care and government programs, health insurance compliance programs, or related fields.
  • 2+ years experience in staff management.
  • Generally conversant with the laws, regulations and guidelines affecting CareFirst.
  • Experience in complex regulatory compliance.
  • Experience in project management, business process analysis, work flow, and task analysis.
  • Experience in Enterprise Risk Management.
  • Experience and deep understanding of corporate insurance programs, claim administration, and risk management strategy development.

 
Abilities/Skills:

  • The ability to effectively manage staff through leadership and the promotion of teamwork is essential. 
  • Incumbent must display leadership qualities, functional expertise, and business perspective.
  • Considerable judgment, tact, initiative, accuracy, trustworthiness, and integrity.
  • Excellent interpersonal skills with ability to build consensus and agreement and bring resolution to contentious issues and entrenched interests.
  • Ability to present and discuss regulatory compliance goals or risk management issues in a way that establishes rapport, persuades others, and gains commitment.
  • 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.
  • Must be able to effectively work in a fast-paced environment, be flexible, and possess the ability to adapt to shifting priorities, to work independently as well as part of a team. Strong customer service, organizational, coordination skills and interpersonal skills for facilitating Compliance audits and insurance renewal submissions.
  • Ability to gather and analyze data and generate reports.
  • Knowledge of local systems (such as Facets, Oracle, PeopleSoft, SunGard, etc.) and experience with hardware and software required to understand how they interface with the compliance regulatory statutes.
  • Knowledge of GAAP and STAT accounting rules and requirements.
  • 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


Preferred:

  • Knowledge of organization and operations of the business areas being supported.
  • Understanding of legal requirements and expectations for health insurance operations.
  • Member of local risk management organization.  Professional certification, such as Associate in Risk Management (ARM) or Certified Compliance and Ethics Professional (CCEP).   A strong knowledge of corporate policies, procedures and operations. 

Department

Department: Risk Management

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

Closing Date

Please apply before: 7/6/2018

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 on Federal health care programs.

Physical Demands:

  • Travel may be necessary to coordinate audits throughout the Finance Division.
  • 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.
  • 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.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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