Senior Regulatory Implementation and Assurance Analyst

Highmark Health; Pennsylvania; Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Health is seeking a senior leader to drive risk case management and intake initiatives across multiple regulatory frameworks. You will guide a global team, translate complex requirements into actionable plans, and report to senior risk stakeholders to support enterprise governance.

The role emphasizes collaboration with risk partners, technology, and compliance teams to ensure audit readiness, policy alignment, and effective risk monitoring across jurisdictions.

Qualifications

• Translate regulatory requirements into business and technical requirements for stakeholders and systems.
• Demonstrate knowledge of risk and control frameworks in healthcare regulatory contexts.
• Plan and coordinate regulatory compliance activities and audits.
• Communicate effectively with senior management and audit committees.

Responsibilities

• Lead large team projects or initiatives involving a global team of specialists.
• Coordinate with impacted departments to identify changes to policies, procedures, processes, and technology based on regulatory requirements.
• Provide regular, executive summaries to Risk Partners, leadership, and the Audit Committee.
• Create and execute regulatory implementation strategies across jurisdictions.
• Support all external audits and ensure information governance and continuity.
• Standardize documentation and tracking of audits and regulatory reviews.
• Prepare status reporting to stakeholders as necessary.

Skills

Regulatory frameworks

Risk management

Policy and procedure

Cross-functional collaboration

Executive communication

Education

Bachelor's degree

Master's degree preferred

Job description

Company : Highmark Health

Job Description : JOB SUMMARY This job is responsible for leading large projects and initiatives related to the risk case management and intake activities of Highmark Health in support of a broad range of frameworks and oversight bodies including NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS, JCAHO, NCQA, the BCBSA, etc. The incumbent will partner with the organizational risk and business partners, the technology organization, and global delivery teams to meet Highmark Health’s mission requirements in a manner consistent with the enterprise risk appetite. The incumbent must have a proactive mindset and approach, and feel comfortable working in a highly matrixed environment.

ESSENTIAL RESPONSIBILITIES

Lead large team projects or initiatives involving a global team of specialists. Coordinate with impacted departments to identify necessary changes to policies, procedures, processes, and technology based on the identification of legislative, regulatory, sub-regulatory, and licensing / accreditation requirements from the Regulatory Guidance team;. Translate and communicate compliance requirements into business and technical requirements for impacted stakeholders and systems. Provide regular, executive summaries/abstracts to Risk Partners, Business Unit leadership, and/or the Audit Committee of the Board of Directors as required. Create and execute complex regulatory implementation strategies for assigned legislative, regulatory, sub-regulatory, and licensing / accreditation requirements across multiple jurisdictions, including assessments of the regulatory impact of changes to people, processes, and technologies deployed across the enterprise. Support all external audits of the organization, including ensuring that a) appropriate agreements are in place before the release of any information, b) the release of information is in accordance with applicable laws and organizational policies, c) information provided to the auditors is complete and accurate, d) chain of custody is maintained, and e) disruption to the daily operations of the Company is minimized. Standardize documentation and tracking of audits, market conduct exams, regulatory reviews, and external accreditation assessments of the organization. During an audit, engage senior Business Unit leadership and removing barriers for outside parties. Prepare and/or provide status reporting to Risk Partners, accountable management, and the Audit Committee of the Board of Directors as necessary. Standardize and expand internal and external risk intake (hotlines, inboxes, self-service, inquiries, vendor pipeline, incident & problem management systems, strategic initiative portfolio, etc.), and provide a streamlined, consistent point of entry for risk tracking, assessment, treatment, and monitoring for all of Highmark Health. Implement policies and procedures to facilitate a consistent, high quality, confidential, and compliant service experience, including establishing service levels and requirements for the department and developing and implementing methods to record, assess, and analyze risk intake. Leverage analytics programs, decision support systems, and standards that apply to complex information sets in order to make logical and supported risk & regulatory implementation recommendations. Other duties as assigned or requested.

EDUCATION

Required Bachelor's degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, Computer, Information Science, or related field Substitutions 6 years of related and progressive experience in lieu of Bachelor's degree Preferred Master's degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, Computer, Information Science, or related field

EXPERIENCE

Required 5 years of interacting with regulators, auditors, and/or oversight bodies 5 years of increasing accountability and/or progressive role, preferably in an audit or compliance discipline in a healthcare or healthcare related industry Preferred None

LICENSES or CERTIFICATIONS

Required None Preferred (any of the following) Certified Public Accountant (CPA) Certified Information Systems Auditor (CISA) Juris Doctor (JD)

SKILLS

Demonstrate knowledge of business and technology processes, risk and control frameworks, and assessment methodologies, particularly as applied to healthcare (payer and provider) business processes Knowledge of relevant regulatory guidelines, vendor management, sourcing and procurement, and completing risk-based assessments Excellent resource and project planning capabilities, decision making skills, history of results-oriented delivery, and effective team building across a cross-campus and diverse team of management and staff Strong written and verbal communication skills for diverse audiences (senior management, board, peer, and team) Strong relationship building skills and ability to influence with and without authority in a matrixed organization. written and verbal communication skills for diverse audiences (senior management, board, peer, and team) Capacity to think analytically, interpret information / observations, apply judgment and make effective, strategic decisions Language (Other than English): None

Travel Requirement

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type Office-based Teaches / trains others regularly Frequently Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range

Pay Range Minimum: $79,300.00 Pay Range Maximum: $127,100.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.