Manager, Contract Compliance

BlueCross BlueShield of South Carolina•Columbia, SC

2d•Onsite

About The Position

Responsible for the implementation and oversight of a comprehensive compliance program that meets all regulatory requirements for commercial and/or government programs products. Oversees federal and state regulatory compliance activities, regulatory filings, and contract and agreement review functions. Ensures products receive regulatory approval in all jurisdictions.

Requirements

Bachelor's in a job related field
With Bachelor's Degree, 7 years audit/compliance or contract administration within the insurance industry including 2 years management or supervisory experience or equivalent military experience in grade E4 or above.
With Juris Doctor Degree, 4 years audit/compliance or contract administration within the insurance or legal field including 2 years management or supervisory experience or equivalent.
Ability to effectively communicate both verbally and in writing to all levels throughout the organization and externally.
Excellent analytical or critical thinking, problem solving, and organizational skills.
Ability to make sound decisions, and exercise confidentiality and discretion.
Proven ability to persuade, negotiate or influence.
Knowledge of contract form, composition, and law.
Familiar with audit or compliance procedures and regulations.
Microsoft Office.

Responsibilities

Initiates, coordinates the negotiation, and monitors implementation of revisions to existing and renewal contracts, certificates, and/or booklets in all applicable jurisdictions to comply with changes in state or federal requirements, with corporate policy, or change in business practice.
Develops and maintains language and structure for all new or revised contracts and related documents, and coordinates the review with all appropriate areas for distribution.
Prepares and submits regulatory filing, and negotiates with regulatory agency staff for required approval.
Participates in the development of recommendations and descriptive language for new or enhanced products for the submissions of group and subscriber fulfillment forms requiring regulatory approval, and negotiates with regulators to obtain such approval.
Informs the Corporation of approval of documents and procedures pertinent to the use of the approved documents.
Ensures that contracts and certificates used are consistent with corporate forms (most currently approved forms, modifications implemented, etc.), and conducts audits on documents to ensure compliance of revisions with corporate and/or legal requirements.
Reviews, analyzes, and interprets proposed language for the contracts, addenda, and correspondence as requested, which may include HMO or P&C statutes and other insurance related questions such as insurance regulations, COBRA, EOL, HIPAA privacy.
Drafts, reviews, and/or modifies various agreements, such as administrative services, general agency, and business associate agreements.
Reviews publications, articles and abstracts, potential bills, and proposed laws, provided by entities such as the Legal Department, Government Affairs, the SC Alliance of Health Plans, State Insurance Departments, and/or Department of Health and Human Services, to stay current of regulations and trends, give input on potential regulations and communicate such to senior staff.
Ensures the appropriate action is taken to incorporate necessary revisions into the workplace environment by facilitating the implementation of regulatory requirements.
Serves as the divisional compliance contact for purposes of complaint receipt and interpretation regarding the insurance laws and regulations.
Responds to state insurance department complaints for products administered by business partners.
Researches, interprets, and evaluates all questions or issues regarding regulatory compliance, coordinating with the Legal Department and others as appropriate.
Directs supervision of personnel supporting contracts and compliance functions including performance evaluations.
Provides ongoing training and development of staff through mentoring and feedback.
May supervise the agent licensing and appointment area, ensure all producers are appropriately licensed and appointed, and oversee the maintenance of the agent database.
Responsible for policy and/or certificate issue system.
Troubleshoots and problem-solves to ensure the policy and/or contract flow process is uninterrupted.
May design and implement HIPAA Privacy and Security compliance programs while ensuring compliance with OFAC, US Patriot Act, and all applicable federal statutes.