Analyst, Compliance - Remote must have Medicare Advantage exp

Molina Healthcare•Long Beach, CA

2d•Remote

About The Position

Molina Healthcare's Medicare Compliance team provides oversight for sales operations for the Molina Medicare product lines. It is a centralized corporate function supporting compliance activities.

Requirements

2+ years related compliance work experience
Exceptional communication skills, including presentation capabilities, both written and verbal.
Excellent interpersonal communication and oral and written communication skills.
High level Interaction with Leadership.
Sales Allegation Investigations
Policy & Procedures
Medicare Advantage experience

Nice To Haves

Certified in Healthcare Compliance (CHC).
Experience with risk assessment methodologies.
Knowledge of internal control frameworks.

Responsibilities

Sales Oversight
Provide regulatory expertise to the Sales Organization: both State and Federal
Have working knowledge of federal and state guidelines pertaining to Sales and Marketing.
Perform internal Sales/Marketing Compliance Reporting.
Perform internal Sales/Marketing monitoring.
Detailed oriented to conduct thorough Sales allegations investigations.
Recommend applicable corrective action(s) when applicable to business partners.
Process improvement driven.
Create, update, and retire P&Ps, Standard Operating Procedures and Training documents.
Lead regularly scheduled Sales & Compliance leadership meetings.
Interpret and analyze Medicare, Medicaid, and MMP Required Sales & Marketing Reporting Technical Specifications.
Create and maintain monthly and quarterly Sales Complaint Key Performance Indicator (KPI) reports.
Review and interpret internal Sales dashboards for outliers and deeper dive research.
Manage compliance Sales Allegations, Secret Shops, and recommend corrective action plans for deficiencies found.
Responds to legislative inquiries/ Sales complaints (state insurance regulators, Congressional, etc.).
Leads projects to achieve Sales compliance objectives.
Interprets and analyzes state and federal regulatory manuals and revisions.
Interpret and analyze federal and state rules and requirements for proposed & final rules for Sales Oversight.
Interact with Molina external customers, via verbal and written communication.
Ability to work independently, and set priorities.