Performs state and federal tracking and communication of emerging law and regulation, monitors business area compliance actions, and provides research on a variety of topics, as relates to the products and business nationwide.
1. Tracks, reviews for impacts and communicates emerging laws and regulations and tracks business area completion of actions to comply.
2. Supports management in participation in industry trade groups and coordination of company positions in response to proposed legislation and regulation to influence emerging law and improve the regulatory environments.
3. Provides research to support projects and respond to inquiries and maintains on-going information sources on key topics.
4. Provides project support and advises other business areas and partners on health care reform as well as other new and existing laws and their operational impacts.
5. Leads compliance initiatives including, but not limited to:
- Conducting an annual compliance risk assessment of all HM and United Concordia departments; documenting and mitigating identified compliance risks; summarizing the assessment results to senior management and the Highmark Integrity and Compliance Department; facilitating corrective action plans (CAPs) and delivering education and training, as needed, to correct identified risks.
- Compliance monitoring to identify state and federal mandates related to the Affordable Care Act; maintaining an automated email reminder system to notify impacted departments of compliance deadlines; and tracking compliance action steps taken by business units.
- Conducting audits of compliance certifications and actions steps to determine impacted business units compliance with previously communicated legislative or regulatory mandates; issuing necessary CAPs with following up to ensure implementation; and related reporting.
- Leading the implementation of new processes and deliverables, as needed.
6. The lead role will additionally perform the following responsibilities:
- develop communications to educate internal and external parties on regulatory requirements and responding to inquiries, RFPs and survey questions from customers, producers, consultants, members, providers, internal staff, other carrier
- provide subject-matter direction and guidance to lower-level analysts; trains employees on department processes and operational matters related to insurance and industry; monitors and reviews progress and accuracy of analysts’ work; coordinates complex projects involving other analysts and/or employees from external business units. partners and other business associates
- coordinate analysts’ work related to conducting annual compliance risk assessments and periodic compliance audits related to compliance certification process
7. Other duties as assigned or requested.
- Juris Doctor degree
- 2 years’ experience in a regulatory position in a multi-state insurance, corporate or governmental setting involving research, interpretation and application of laws and regulations.
- 5-10 years of relevant, progressive experience in the area of specialization
- Licensed attorney in any United States jurisdiction
- 1 to 3 years’ experience in a health insurance position involving analysis and communication of legislation and/or government relations activities
Knowledge, Skills and Abilities
- In-depth knowledge of federal and state regulatory agencies, legislative processes, and insurance and benefits laws and regulations related to products, networks and delivery systems, marketing, administration, privacy, self-funded plans.
- In-depth knowledge of insurance administration, distribution, networks, customer service processes, insurance policy forms and issuance.
- Participation in government affairs activities related to the insurance industry
- Strong electronic research skills and ability to apply findings to solving business problems.
- Keen attention to detail, organizational skills and ability to multi-task
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 their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org