Compliance Program Administrator I
Excellus BlueCross BlueShield - Rochester, NY

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Under the direction of the assigned management, this position assesses new and existing regulatory, ethics and/or privacy issues to determine implications and develops practical solutions as issues are identified. Executes and manages compliance and/or governance matters through implementation. Assesses compliance, privacy and/or governance vulnerabilities, conducts root-cause analysis, and recommends, initiates and oversees process improvement activities. Identifies compliance and/or governance best practice opportunities, recommends process refinements, brings practical improvements to implementation and produces policy recommendations. Provides oversight and management of regulatory, governance, ethics and/or privacy requirements, implementation and monitoring for compliance performance to meet corporate goals.

Essential Responsibilities/Accountabilities
All Levels
• Assesses the business impact for state and federal regulations and mandates.
• Works directly with business area staff, Compliance Oversight Committee and Legal Counsel to define and document requirements for implementation.
• Researches, interprets and communicates regulation requirements to internal customers. Provide and support training or reference materials as appropriate.
• Independently facilitates, establishes, manages and monitors work teams to successfully implement requirements in operation areas.
• Develops and executes compliance communication tools and training and monitoring programs to ensure continued compliance.
• Assesses potential non-compliance vulnerabilities, identifies root causes of issues and provides practical business recommendations for corrections. Works with business area ambassadors to develop recommendations and reach meaningful and appropriate resolutions.
• Develops and manages analysis to promote and ensure compliance across the corporation
• Develops, maintains and analyzes Compliance reports including those related to regulatory commitments, Ad Hoc Corporate issues and all general compliance issues.
• Initiates and executes long and short-range planning processes and schedule resources required to meet plans and objectives.
• Identifies the level of support required within areas of responsibility.
• Effectively communicates ethics, privacy, and compliance policies, procedures and practices to all employees, Boards of Directors and other agents through publications, training and educational programs.
• Develops and implements communication vehicles to address expectations of employee behavior.
• Serves as technical expert in the design, development and delivery of employee education and training programs regarding compliance with applicable laws, regulations and the code of conduct.
• Provides expert advice and interpretation of the Code of Conduct, Conflict of Interest, Ethics and Privacy including the applicability of corporate policies and procedures to specific situations for employees and Boards of Directors.
• Develops reports, prepare and assure accuracy of information provided to outside counsel to support annual filings to regulators and other requests from regulators as received.
• Maintains strict confidentiality related to matters of the corporations and Boards of Directors.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II – performs similar functions as level I, plus:
• Displays more autonomy with assignments and acts as a resource to operational areas regarding compliance and governance matters.
• Performs compliance and/or governance on more complex audits and oversees the implementation of new regulatory mandates

Level III - performs similar functions as level II, plus:
• Manages the highest level of complex compliance issues and exercises decision-making in project work groups.
• Provides guidance to less experienced team members and internal customers. Acts as a resource for the department.

• Develops reports, prepare and assure accuracy of information provided to outside counsel to support annual filings to regulators and other requests from regulators as received.
• Maintains strict confidentiality related to matters of the corporations and Boards of Directors.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II – performs similar functions as level I, plus:
• Displays more autonomy with assignments and acts as a resource to operational areas regarding compliance and governance matters.
• Performs compliance and/or governance on more complex audits and oversees the implementation of new regulatory mandates

Level III - performs similar functions as level II, plus:
• Manages the highest level of complex compliance issues and exercises decision-making in project work groups.
• Provides guidance to less experienced team members and internal customers. Acts as a resource for the department.

Level 1
• Bachelor’s degree in related area with a minimum of five years related experience or compliance training. In lieu of degree, a minimum of nine years in health insurance or health care delivery.
• Knowledge of corporate operations, corporate goals and objectives and the organization’s structure.
• Extensive knowledge of regulatory initiatives and legislation that impacts the Corporation.
• Excellent written and verbal communication skills.
• Strong analytical and organizational skills and ability to manage multiple projects simultaneously with minimal management directive.
• Excellent PC skills including Word, Excel, Access and Lotus Notes.
• Proven project management/implementation skills required.

Level II - requires similar qualifications as level I, plus the following:
• Bachelor’s degree in related area with a minimum of seven years of related experience or training. In lieu of degree, a minimum of twelve years in health insurance or health care delivery.
• Ability to independently perform compliance and/or governance audits and oversee the implementation of new regulatory mandates.

Level III - requires similar qualifications as level I & II, plus the following:
• Bachelor’s degree in related area with a minimum of ten years of related experience or training. In lieu of degree, a minimum of fifteen years in health insurance or health care delivery is required.
• Demonstrated abilities in handling the highest level of complex compliance issues and exercises decision-making in project work groups.

Physical Requirements

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Excellus BlueCross BlueShield - 18 months ago - save job - block
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