CareFirst Careers

Compliance & Ethics Program Director

Resp & Qualifications

PURPOSE:  Under the direction of the VP, Chief Compliance, Ethics & Privacy Officer, the Program Director provides for the general strategic development, design, implementation, promotion and maintenance of the Corporate Compliance and Ethics Program for the purpose of ensuring an ongoing culture of compliance and ethical behavior and the prevention of illegal or unethical behavior. The incumbent will advise and collaborate with other management and staff to promote a culture of compliance and ethical behavior, to continuously improve methodologies, best practices and policies, and to solve compliance issues and concerns. The Program Director is responsible for providing oversight, management, and support of the Internal Investigations conducted in the Compliance and Ethics Office.

PRINCIPAL ACCOUNTABILITIESTo fulfill the above purpose, the Program Director, under the direction of the VP, Chief Compliance, Ethics & Privacy Officer, is responsible for, among other duties:

Developing, implementing and managing elements of the Company’s Compliance and Ethics Program. This includes periodic revisions and/or updates in response to new and emerging risk areas, changes in the Company’s needs and statutory and regulatory requirements of the following documents: the Compliance and Ethics Program, the Corporate Code of Ethical Business Conduct; the Contractor Code of Conduct; Compliance Certifications and the Compliance Steering Committee Charter.  Managing the annual and ongoing Conflict of Interest Disclosure process, working with Human Resources, Legal, and senior management to identify, investigate, and manage conflicts, preparing standardized and customized responses to, document, and track identified conflicts. Overseeing the coordination of the integrated compliance and ethics liaisons, including but not limited to the Compliance and Ethics Steering Committee.

Directing and managing the Internal Investigations process, including strategic oversight and supervision relating to the overall planning and implementation of investigations. Partnering with HR to conduct investigations and recommend action plans. Serve as subject matter expert on the proper procedure and process for conducting investigations and ensuring that all investigation information is maintained in the C360 module.

Strategically developing and expanding the visibility of the Corporate Compliance and Ethics Program at all levels within the Company which includes:
Working with Human Resources and Corporate Communications to develop and coordinate customized educational and training materials and messaging that promote compliance and ethics in the workplace.
Partnering with key stakeholders across the Company to effectively and consistently communicate and promote the Compliance and Ethic Program brand and expectations under the program.
Overseeing the development and execution of department initiatives including Annual Compliance and Ethics Week. Supervising the coordination and management of the Compliance and Ethics Helpline.
Monitoring and assessing current compliance/ethics industry trends and activities to identify and develop best practices and initiatives that foster an ethical culture.

Developing and participating in ongoing efforts to measure and improve the effectiveness of the Corporate Compliance and Ethics Program as required by the U.S. Federal Sentencing Guidelines for Corporations.  Maintaining general knowledge of current laws and regulations that affect the Company in order to assist with corporate policy development and regulatory compliance issues.

Represent VP of Compliance and Ethics at internal and external meetings as appropriate.


MINIMUM QUALIFICATIONS:

Required Experience/Skills/Abilities:

  • Juris Doctorate and at least 8-10 years of health insurance regulatory or compliance experience.  Of the 8 years of required experience at least 3 years must be in progressive leadership. 
  • This position demands strong analytical, interpersonal, and verbal communication skills. In addition, must possess clear, concise and persuasive writing and presentation skills – must influence and persuade all levels of associates in the organization.
  • Maintains strong writing skills required to write and edit policies and procedures, issue memorandums and compile program reports. 
  • Must have the ability to follow instructions, to be flexible/versatile, and to work independently with minimal supervision. 
  • Experience in state and federal regulatory oversight is essential.
  • Familiarity with operational, financial, quality assurance, and human resources procedures and regulations in the health insurance field.
  • Experience conducting internal legal investigations and drafting investigation reports.
  • Solid PC skills such as Microsoft Office Suite (Excel, PowerPoint, Word) as well as familiarity with automated tracking databases.
  • Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can vary 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.


Preferred

  • Understanding of the legal regulatory framework of the organization.
  • Certification in Compliance and Ethics




 

Department

Department: 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

Closing Date

Please apply before: 08/23/2019

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:

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

Learn more about Audit & Legal