Communication Compliance Specialist - Remote / Telecommute

Cynet Systems Inc; Wayne (PA); Remote; Full time

Job summary

A leading company in Pennsylvania is seeking a compliance specialist to liaise with regulatory agencies, ensuring adherence to laws and regulations. The successful candidate will engage with various internal departments, providing strategic insights and support in legal matters, requiring significant experience and excellent communication skills.

Qualifications

• Must have significant experience in compliance or similar roles.
• Ability to interpret insurance law and regulations is essential.
• Excellent critical thinking and professional communication skills required.

Responsibilities

• Liaison with regulatory agencies and ensure compliance.
• Research and respond to inquiries from various officials.
• Prepare documentation for legal actions and attend depositions.

Skills

Critical Thinking

Communication Skills

Logic and Reasoning

Education

5 years experience in compliance or senior customer service role

Alternative 4 years of relevant work experience

Job description

Job Description:

Pay Range: $46hr - $51hr

Essential Functions:

• Liaison with Regulatory Agency Investigators (Maryland Insurance Administration {MIA}, Virginia Bureau of Insurance {VBOI} and the District Insurance, Security and Banking {DISB}, organization as well as state and federal level bureaucrats.
• Frequent interaction with all internal areas especially all Business Units, Legal, Compliance and Legislative Departments.
• Provide interpretation of regulations and regulatory rules/guidelines to demonstrate Client and its subsidiaries' compliance with state and federal standards.
• Review and analyze all data received in order to generate detailed responses to the originating party.
• Strategizes with Legal and Compliance as needed to identify the best response to the complaint.
• 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.
• Serves as the subject matter expert for business processes and related systems as the representative of the company.
• Provide education regarding systems and processes to regulators as needed and requested.

30% Business Support:

• Research, resolve and respond to written inquiries forwarded from Congressional, Attorney General and State officials, members, providers, groups and brokers.
• Coordinate with internal and external parties to ensure accurate information is obtained.
• Review and analyze provided data and information.
• Provide detailed professionally written responses to the originating party, ensuring all questions are answered and customer needs are effectively served within designated time frames while ensuring privacy needs of members are respected.
• Review, analyze, prepare detailed documentation for support of legal action pertaining to indemnity business, ensuring that all appropriate materials, related claims, contracts, payment vouchers are included.
• Develop a summary/assessment of included documentation for legal staff.
• Meet, discuss, and strategize with legal staff to prepare for depositions, court cases or administrative hearings.
• Appear as required to testify on behalf of the company.

15% System Compliance Analysis:

• Review moderately complex business processes and systems to identify, document, elevate the presence of risks and trends within systems and processes that may be non-compliant with contracts and or statutory requirements especially in the claims processing, enrollment and service arenas – all jurisdictions, all products, all processing platforms to include our subsidiaries.
• Actively participate in implementation/corrective workgroups to ensure compliance perspective and concerns are addressed through the process.

15% Litigation and Legal Support:

• Review, analyze, prepare detailed documentation for support of legal action pertaining to indemnity business, ensuring that all appropriate materials, related claims, contracts, payment vouchers are included.
• Develop a summary/assessment of included documentation for legal staff.
• Meet, discuss, and strategize with legal staff to prepare for depositions, court cases or administrative hearings.
• Appear as required to testify on behalf of the company.

10% Special Projects:

• Provide research, investigative and analytic support on special projects ensuring that all policies and contractual guidelines are clearly identified.
• Provide support to supervisors and other internal associates with written responses to inquiries.

Qualifications:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• The requirements listed below are representative of the knowledge, skill, and/or ability required.
• accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education:

• 5 years experience in a compliance or senior level customer service role.
• In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Knowledge, Skills and Abilities:

• Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems., Advanced
• Ability to convey information in a clear, concise, and logical manner., Advanced
• Ability to effectively convey information to others., Advanced
• Excellent critical thinking and communication skills both written and verbal. , Advanced
• Consistently maintains highly professional written and verbal interaction with all levels of staff within the company and with members of regulatory agencies., Advanced
• Must be able to interpret insurance law and regulations. , Advanced