Regulatory Compliance Specialist

Blue Cross and Blue Shield of Kansas City; United States; Remote; USD 70,000 - 100,000; Full time

Job summary

A leading health insurer seeks a Compliance Officer responsible for product development compliance and adherence to health regulations. Candidates should have a relevant Bachelor's degree and 3-5 years of experience in compliance roles. This position requires strong analytical skills and the ability to interpret complex laws while ensuring product compliance.

Benefits

Comprehensive medical, dental, and vision benefits

401(k) plan with contributions from both parties

Annual incentive bonus plan

Paid parental leave

Tuition reimbursement program

Qualifications

• 3-5 years' experience in a compliance, legal, or audit role.
• Excellent skills in explaining complex technical requirements.
• Experience in producing detailed quality work with tight deadlines.

Responsibilities

• Ensures timely development and availability of health insurance products.
• Monitors compliance with state and federal regulations.
• Leads investigations of compliance issues.

Skills

Communication

Analytical skills

Prioritization

Reading and interpreting laws

Education

Bachelor's degree in relevant discipline

Job description

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program

Job Description Summary: Independently, ensures timely development and availability of health insurance products including group and direct pay contracts, member certificates, applications, alternative funding agreements, and agreements for self-funded plans, and ensures all associated documents are clear, concise and comply with applicable regulatory requirements. Supports and leads the company’s efforts to ensure compliance with state and federal laws and regulations including compliance oversight of activities performed on behalf of the company by downstream and delegated entities. Job Description

• Drafts, submits, monitors, obtains approval for, and maintains necessary group and member contracts and related materials (e.g., contracts, certificates, applications, agreements, et al.) that are clear, concise, and comply with applicable regulatory requirements.
• Reviews, maintains, and codes contract/certificate/group contracts updates in internal document management system.
• Updates self-funded documents including summary plan descriptions (SPDs), administrative services agreements (and amendments thereto), health care reimbursement/personal care account plan documents and service agreements.
• Maintains detailed knowledge of applicable current and proposed laws, regulations, and sub-regulatory guidance (e.g. CMS, IRS, DOL, States)
• Assists Blue KC’s business and customers with regulatory issues related to state and federal statutes and regulations applicable to health insurers and health care providers, including COBRA, ERISA, SAMHSA, HIPAA, and the Mental Health Parity and Addiction Equity Act, and the Affordable Care Act
• Monitors, analyzes, interprets, summarizes, and distributes laws, regulations, and guidance. Coordinates with operational owners to monitor implementation of new and changed laws, regulations, and guidance. Serves as subject matter expert to Organization.
• Prepares summaries, memoranda, or white papers related to newly enacted or revised statutes and regulations for distribution to key stakeholders and senior leadership and works in partnership with operational areas and vendor to facilitate implementation of effective policies, processes, and internal control to comply with new or changing requirements.
• Assists in the preparation of responses and helps coordinate data collection for inquiries from external regulators and investigators, as well as for various regulatory reporting requirements.
• Researches and responds to inquiries from internal and external customers regarding compliance topics (e.g., questions concerning pending legislation, statutes, regulations, and litigation) with minimal guidance. Provide oral and written guidance regarding regulations and guidance that impact the company’s products and business.
• Supports ongoing monitoring processes and programs for internal and delegated activities to evaluate levels of compliance, identify risks, correct issues or improve compliance where necessary, and monitor implementation of corrective actions
• Leads and participates in cross-functional workgroups to implement new benefits, programs, and ensure ongoing compliance.
• Lead timely investigations of compliance issues/risks reported to Compliance or identified through ongoing monitoring and auditing. Ensure effective root cause analysis and documentation of the investigation. Collaborate with other risk management functions on investigations as necessary (e.g., Special Investigations Unit, Privacy, Corporate Compliance, Internal Audit, Human Resources, and Legal). For compliance issues/risks identified, recommend corrective actions to improve compliance risk management processes and controls to address specific issues/risk identified and their root cause(s).
• Assist in developing Compliance Committee materials for clear, concise reporting of: compliance issues/risks and related action plans; monitoring and auditing plans; annual and quarterly compliance program objectives and plans; and the status/results of compliance program activities.

Minimum Qualifications

• Bachelor’s degree in political science, business, finance, health care administration, medical or other relevant academic discipline;
• 3-5 years' experience in a compliance, legal, or audit role at a healthcare organization, health insurer or other highly regulated entity
• Excellent communication skills, specifically in explaining complex technical requirements to stakeholders with varying levels of subject matter expertise
• Experience in reading, analyzing, and interpreting complex laws, regulations, and other guidance
• Ability to prioritize competing demands as an individual and member of a team with minimal guidance
• Experience communicating with a broad range of individuals and groups, including employees, senior management, and regulators
• Experience producing detailed, superior quality work products with changing due dates and short turnaround times.

Preferred Qualifications

• Master's Degree in Law, business, finance, health care administration, or other relevant academic discipline
• Juris Doctor (J.D.)
• Working knowledge of state and federal laws and regulations relating to health insurance (e.g., ACA, ERISA, HIPAA, benefit mandates)

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.