Senior Regulatory Compliance Analyst - (Remote)

CareFirst•Baltimore, MD

4d•Remote

About The Position

The Senior Regulatory Compliance Analyst conducts independent analysis of complex regulatory inquiries and interprets regulatory rules and guidelines to demonstrate compliance with state and federal requirements. The role audits internal controls to identify high-risk exposure, recommends corrective actions to business areas, and tracks implementation of remedial solutions. The analyst serves as a liaison with insurance regulators and state and federal officials, and works frequently with internal business units, Legal, Compliance, and Legislative departments. The role researches and responds to inquiries from public officials, members, providers, groups, and brokers; coordinates with internal and external parties to obtain accurate information; and prepares detailed, professional responses within established timeframes while protecting member privacy. The position reviews business processes and systems to identify and document risks and trends that may conflict with contractual or statutory requirements, particularly in claims processing, enrollment, and service. It also supports legal actions and special projects by gathering and assessing documentation, collaborating with legal staff, and testifying on behalf of CareFirst when required. The position has no direct reports but may mentor less experienced staff and lead matrixed resources.

Requirements

Bachelor's degree, or an additional four years of relevant work experience in lieu of a bachelor's degree.
Five years of experience in a compliance or senior-level customer service role.
Ability to use logic and reasoning to assess alternative solutions, conclusions, or approaches to problems.
Ability to convey information clearly, concisely, and logically.
Excellent critical-thinking and written and verbal communication skills.
Ability to interpret insurance law and regulations.
Ability to meet deadlines and manage multiple internal and external customer-service demands within established service expectations.
Ability to provide effective, positive customer service, including to demanding or challenging customers.
Must be eligible to work in the United States without sponsorship.
Must immediately disclose any debarment, exclusion, or other event that makes the employee ineligible to perform work directly or indirectly on Federal health care programs.

Responsibilities

Liaise with regulatory agency investigators and state and federal officials, maintaining positive and professional relationships.
Interpret regulations and regulatory guidelines to demonstrate compliance with state and federal standards.
Review and analyze information received and prepare detailed responses to originating parties.
Coordinate with Legal and Compliance to determine appropriate responses to complaints.
Research, resolve, and respond to written inquiries from Congressional, Attorney General, and State officials, members, providers, groups, and brokers.
Coordinate with internal and external parties to obtain accurate information and respond within designated timeframes while respecting member privacy.
Review business processes and systems to identify, document, and elevate risks and trends that may be non-compliant with contracts or statutory requirements.
Participate in corrective-action workgroups to ensure compliance concerns are addressed.
Prepare and assess documentation supporting legal actions, including relevant claims, contracts, and payment vouchers, and provide summaries to legal staff.
Work with legal staff to prepare for depositions, court cases, and administrative hearings; testify on behalf of CareFirst when required.
Provide research, investigative, and analytical support for special projects, identifying relevant company policies and contractual guidelines.
Support supervisors and internal associates with written responses to inquiries.
Assist in guiding and mentoring less experienced staff and potentially lead matrixed resources.