Head of Health Plan Compliance & Operations

Stryker Corporation; Durham (NC); Hybrid; Confidential; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401k match

Paid Time Off (PTO)

Job summary

Blue Cross NC seeks a strategic leader to guide Health Plan compliance across Medicare, Commercial, and FEP, implementing initiatives that drive efficiencies and compliant outcomes within an enterprise framework.

You will oversee training, reporting, and budgets, collaborating with the Enterprise Compliance Office to resolve issues. The role demands leadership and deep regulatory know-how across a national footprint in Durham, NC.

Qualifications

• Bachelor's degree or Advanced Degree.
• 10 years experience in health insurance, health care operations or legal with at least 4 of those years in a compliance, regulatory and/or Medicare role.
• Detailed knowledge of state and federal insurance law, especially health insurance and managed care.
• 5 years of progressive leadership experience.
• In lieu of degree, 12+ years of experience in related field.

Responsibilities

• Lead the development of the strategy, planning and execution necessary to implement legislation and facilitate implementation of strategies and processes that ensure compliance and achieve operational effectiveness and efficiencies.
• Direct the maintenance and evaluation of an operational compliance program that meets federal guidelines and regulatory requirements and is deployed to all areas of the Health Plan.
• Develop and deploy communication and training initiatives that support operational compliance goals and obligations.
• Establish standards and procedures for reporting and documentation, monitoring results against specifications, investigation and mitigation of compliance issues.
• Partner with the Enterprise Compliance Office to direct compliance issues to appropriate channels for investigation and resolution.
• Lead and oversee management and delivery of enterprise and departmental projects including business case development, ROI analysis, planning, business analysis, and project management.

Skills

Leadership

Compliance

Regulatory knowledge

Project management

Education

Bachelor's degree or Advanced Degree

Job description

Blue Cross NC seeks a strategic leader to guide Health Plan compliance across Medicare, Commercial, and FEP, implementing initiatives that drive efficiencies and compliant outcomes within an enterprise framework.

You will oversee training, reporting, and budgets, collaborating with the Enterprise Compliance Office to resolve issues. The role demands leadership and deep regulatory know-how across a national footprint in Durham, NC.