Hybrid Compliance & Risk Specialist

Florida Blue Group; United States; Ibrido; USD 78.000 - 126.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health Insurance

Retirement savings plan

Paid time off

Disability programs

Descrizione del lavoro

Florida Blue seeks an experiencedCompliance Specialist to join the team. You will liaise with internal clients and departments to ensure regulatory and policy adherence, identify risks, and implement robust compliance programs.

You will monitor policies, develop and revise procedures, research data for decisions, and produce audit-related documents. The role involves leading projects, mentoring staff, and supporting UM compliance with CMS and NCQA standards.

Competenze

• 5+ years related work experience.
• Related Bachelor’s degree or additional related equivalent work experience
• Demonstrated experience with audits ensuring compliance with policies and regulations.
• Proven experience leading large, complex departmental or divisional projects.
• Ability to identify risks, evaluate controls and recommend compliant programs.
• As part of the interview, compliance policy knowledge with business impact analysis may be required.
• Knowledge of Medicare Advantage, Commercial, and ACA plan-specific UM compliance requirements (CMS, NCQA, FL Statutes)

Mansioni

• Liaise between internal clients and departments to ensure law and policy compliance.
• Identify risks, evaluate controls and prepare findings; implement compliance programs.
• Monitor and improve solutions, policies and processes for high-quality services.
• Develop, implement and revise policies and programs to meet needs.
• Research and present data and findings for business decisions.
• Produce and edit reports, policies, audit results and marketing materials.
• Create meetings, trainings and webinars for internal/external audiences.
• Represent function at external hearings, audits and meetings.
• Lead large projects or participate in cross-functional initiatives.
• Build internal/external partnerships to improve collaboration.
• Mentor coworkers on technical and interpersonal skills.
• Support Florida Blue's UM by ensuring CMS/NCQA adherence.

Conoscenze

Audits experience

Compliance knowledge

Risk assessment

Project leadership

Communication skills

Interpersonal skills

Formazione

Bachelor’s degree or related equivalent work experience

Descrizione del lavoro

Florida Blue seeks an experiencedCompliance Specialist to join the team. You will liaise with internal clients and departments to ensure regulatory and policy adherence, identify risks, and implement robust compliance programs.

You will monitor policies, develop and revise procedures, research data for decisions, and produce audit-related documents. The role involves leading projects, mentoring staff, and supporting UM compliance with CMS and NCQA standards.