Principal Compliance Advisor

Blue Cross and Blue Shield of North Carolina

20h • Hybrid

About The Position

At Blue Cross NC, we’re making health care better for all – by listening deeply, challenging what’s possible, and putting care at the heart of everything we do. Join a purpose driven team where ideas spark change, growth is encouraged, collaboration fuels impact, and you’re supported with the flexibility and trust to do meaningful work. The Principal FEP Compliance Advisor is responsible for leading complex compliance-related projects and regulatory implementations required to maintain an effective compliance program, including the coordination of highly complex, cross functional matters. Identifies compliance risks, develops and/or facilitates implementation of corrective action plans and conducts audits/compliance reviews to monitor ongoing compliance, and may be responsible for communications and/or negotiations with external regulators. This role manages complex compliance-related projects to ensure regulatory requirements are achieved, supports enterprise projects to consult and advise on strategic directives, avoid compliance risk and exposure, and to determine regulatory impacts. It involves analyzing and interpreting regulatory laws, guidance, and regulations to disseminate requirements to impacted areas, provide education, communicate critical timeframes, and track status of implementation through completion. The FEP Compliance team has ultimate accountability for implementation of regulatory requirements and is responsible to escalate requirements that fail to meet the required deadlines to both Senior Management and Compliance Committees. The advisor conducts FEP risk assessments to identify areas of compliance risk that could result in potential regulatory fines/sanctions/penalties, with results assisting in the development of the Corporate Compliance and Corporate Audit enterprise-wide audit schedules. This position serves as the primary company liaison to external regulators including the NCDOI, CMS, BCBSA-FEPDO, OPM, etc., managing regulatory relationships through audits (including negotiations of audit findings), reporting of compliance matters, regulatory filings, responding to compliance related complaints, and general compliance inquiries. It supports compliance concerns which are chaired by business disciplines and the AVP of FEP, through reporting of key compliance metrics and issues. Compliance is accountable to and provides regular compliance reports to senior-most leaders and BCBSA-FEPDO Program Assurance. Collaboration with Legal allows Consultants to provide information regarding compliance risk to help develop legal opinions which enable critical decisions to be made to impact the enterprise. The advisor also serves as the audit lead or as audit support to the Blue Cross Blue Shield Association, and Office of Personnel Management for the Compliance Program Effectiveness Audit in which Blue Plans agree to conduct audits of each other to assess compliance effectiveness.

Requirements

• Bachelor's degree or advanced degree (where required)
• 8+ years of experience in related field.
• In lieu of degree, 10+ years of experience in related field.

Nice To Haves

• Consulting level experience or progressive leadership experience dealing with regulators, auditors and executives preferred.
• Strong interpersonal skills and ability to communicate with various levels of leadership
• Project Management Skills
• Comfortable with process mapping, Excel and PowerPoint tools
• Problem management and client engagement experience

Responsibilities

• Leading complex compliance-related projects and regulatory implementations required to maintain an effective compliance program, including the coordination of highly complex, cross functional matters.
• Identifying compliance risks.
• Developing and/or facilitating implementation of corrective action plans.
• Conducting audits/compliance reviews to monitor ongoing compliance.
• Being responsible for communications and/or negotiations with external regulators.
• Managing complex compliance-related projects to ensure regulatory requirements are achieved.
• Supporting enterprise projects to consult and advise on strategic directives, avoid compliance risk and exposure, and to determine regulatory impacts.
• Analyzing and interpreting regulatory laws, guidance, and regulations to disseminate requirements to impacted areas, provide education, communicate critical timeframes, track status of implementation through completion.
• Escalating requirements that fail to meet the required deadlines to both Senior Management and Compliance Committees.
• Conducting FEP risk assessments to identify areas of compliance risk that could result in potential regulatory fines/sanctions/penalties.
• Serving as the primary company liaison to external regulators including the NCDOI, CMS, BCBSA-FEPDO, OPM, etc.
• Managing regulatory relationships through audits (including negotiations of audit findings), reporting of compliance matters, regulatory filings, responding to compliance related complaints, and general compliance inquiries.
• Supporting compliance concerns which are chaired by business disciplines and the AVP of FEP, through reporting of key compliance metrics and issues.
• Providing regular compliance reports to senior-most leaders and BCBSA-FEPDO Program Assurance.
• Collaborating with Legal to provide information regarding compliance risk to help develop legal opinions.
• Serving as the audit lead or as audit support to the Blue Cross Blue Shield Association, and Office of Personnel Management for the Compliance Program Effectiveness Audit.

Benefits

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
• Annual Incentive Bonus
• Paid Time Off (PTO)

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 1,001-5,000 employees