BlueCross BlueShield of Western New York

About BlueCross BlueShield of Western New York


Job Category:



United States

Postal Code:


Approximate Salary:

Not Specified

Position Type:

Full Time

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Spec Senior Corporate Compliance

Posted: 09/11/2018

Auto req ID 1947BR Company HealthNow NY, Inc. About Us HealthNow New York Inc. is one of New York’s leading health care companies that provide access to quality health care and innovative solutions for individuals and employers. HealthNow offers a full range of insured, self-insured, and government programs and services, as well as life and disability coverage, dental and vision plans and stop-loss coverage. Headquartered in Buffalo, NY, the company operates BlueCross BlueShield of Western New York (Buffalo), BlueShield of Northeastern New York (Albany), Health Now Brokerage Concepts (Blue Bell, PA) and Health Now Administrative Services (across the Northeast US and California). In 2013 the company had revenues of $2.46B and reserves of $592 million. Title Spec Senior Corporate Compliance Position Posting Location Buffalo Status Full Time Regular Hours As required Job Description The Senior Specialist, Corporate Compliance is responsible for evaluation of policies and procedures to ensure compliance with federal and state regulations and the coordination of education and training materials. The incumbent conducts and provides oversight of compliance and regulatory investigations at the direction of the Manager, Regulatory Compliance. Primary Responsibility - Assists business operations in designing and implementing of requirements and effective ongoing compliance monitoring activities relative to compliance processes and practices
- Conducts compliance program data collection, analysis and trending
- Prepares oral and written reports for compliance officer for presentation to ensure that all compliance concerns, requirements, and responsibilities are addressed
- Maintains a working knowledge of major regulatory changes affecting the business operations in order to monitor and ensure compliance
- Manages the development, maintenance and revision of compliance policies and procedures through appropriate communication and development or modification of policies and procedures
- Makes recommendations for continuous program improvements consistent with applicable regulatory guidelines, federal and state laws
- Develops and provides reporting on the compliance and privacy training programs, as well as the annual training refresher
- Monitors training compliance, provides reports, and notifies management as needed
- Coordinates and/or conducts compliance investigations or complaints of alleged violations of law, regulation and the Code of Conduct
- Ensures follow-up, resolution and the necessary corrective action is taken
- As directed by the Manager, Regulatory Compliance, responds to authorized law enforcement or regulatory agencies if violation requires such reporting
- As assigned by the Manager, Regulatory Compliance, serves as a member of Corporate Committees and presents reports or recommendations for corrective actions on compliance issues
- Oversees, tracks and reports corrective action plans in instances of non-compliance.
- Assists in identification of root cause and appropriate resolution
- Assists in the development of new regulatory and compliance programs or processes, such as oversight on FDR compliance requirements, and fraud and waste detection. These programs include, but are not be limited to, risk assessment, report development, training, monitoring and auditing
- Develops programs which perform exclusion and debarment screening on new employees, consultants, governing body members, vendors and providers
- Reviews or disburses updated information for screening purposes on a regular basis
- Assists the Compliance Officer with day-to-day operations of the Compliance Program and pursuing the compliance department objectives
- Coordinates with departmental compliance specialists to achieve an effective compliance program
Knowledge and Skills - Knowledge of compliance, privacy, ethics or regulatory concepts and procedures
- Ability to read, understand and apply a variety of correspondence, law material, reports, legal documents and proposed and actual legislation and regulations
- Attention to detail is critical in this position
- Ability to perform research using reference materials generally available within a law library and/or electronic resource tools such as Westlaw and LexisNexis. May use research sources other than legal or regulatory ones
- Ability to analyze and interpret moderate to complex information and/or data on a frequent basis
- Ability to work in a fast-paced, collaborative environment with minimal supervision
- Project coordination skills including business process modeling, strong follow-up, meeting facilitation and risk assessment/mitigation
- Excellent verbal and written communication skills, including by phone, email, correspondence and documentation
- Ability to create and present effective and persuasive public presentations
- Working knowledge of Microsoft Office applications with intermediate proficiency, to include the ability to set up spreadsheets, create formulas and manage databases
Experience - Three (3) - six (6) years experience in compliance, privacy and security regulations, ethics or internal audit business environment required
- Prior experience with contracts and requirements of the Centers for Medicare and Medicaid Services preferred
Education - A certificate of completion or a degree from an American Bar Association (ABA) approved paralegal program or post secondary institution required Working Conditions - Must be able to work in an office environment
- Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
- Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc.)
- Physical Effort: Minimum; typical of most office work. Mostly sedentary work. Prolonged Sitting
- Vision Req: Close vision (clear vision at 20 inches or less)
- Weight: lift/carry/push/pull under 10 lbs.
EEO Statement All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status. Removal Date 23-Aug-2019

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