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    Operations Compliance Specialist I/II - Meridian, United States - Blue Cross and Blue Shield Association

    Blue Cross and Blue Shield Association
    Blue Cross and Blue Shield Association Meridian, United States

    4 weeks ago

    Default job background
    Description
    Blue Cross of Idaho is seeking an Operations Compliance Specialist to be a part of our Risk Adjustment team.

    This role will ensure our compliance with governmental laws and regulations for Government lines of business and/or operations area of the organization.


    We're seeking for a Specialist with:
    Experience: 2 years' (level I) or 4 years' (level II) health industry, internal audit, legal, compliance, or government programs experience

    Education:
    Bachelor's Degree or equivalent work experience (Two years' relevant work experience is equivalent to one-year college)


    Your day may look like:

    • Maintain and apply knowledge of business rules and regulations/regulatory changes relevant to the industry and to the organization.
    • Development of internal documentation including policies, procedures and Business Rule Documentation.
    • Manage the collection and submission of all regulatory required reports and information requests.
    • Work directly with regulatory contract monitors to address member, provider, and ad hoc inquiries.
    • Monitor areas of risk and call out concerns to leadership and/or the compliance department.
    • Coordinate, direct, and monitor activities across regulatory lines of business.
    • Identify, facilitate, and develop specialized training needs specific to regulatory lines of business.
    • May develop audits to identify and assess areas of compliance and privacy risk.
    • May review complaints for regulatory compliance. May determine root cause and issue corrective actionable recommendations to leadership.
    • May maintain and track submission of marketing materials to state regulators.
    • Performs other duties and responsibilities as assigned.
    Reasonable accommodations

    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


    We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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