The Compliance Specialist is responsible for analyzing and communicating state insurance legislation to ensure product compliance. In addition, this position completes Medicare Secondary Payer responses and tracks and maintains broker licenses, employee HIPAA training certifications and assists with internal audit functions.
Essential Duties & Responsibilities
Reviews state mandates sent from insurance carriers and analyzes them for impact to the business Responds with proof of mandate compliance as appropriate Updates and distributes internal compliance documentation regarding state regulations and statutes Drafts new compliance forms, procedures and instructions Distributes updated information in a timely manner Initiates, researches and completes Medicare Secondary Payer responses Assists in Medicare Demand Billing cases to provide resolution Tracks and maintains broker licenses and contacts, Broker Errors & Omissions insurance and renewal dates for both Tracks and maintains other compliance licenses, employee HIPAA training certifications Completes department audits, NY Pool report and ad hoc reports and correspondence Misc. duties as assigned Works overtime as needed based on business needs
Knowledge, Skills & Abilities
Knowledge of health insurance benefit plans and administration to include how to research, read and interpret State insurance laws and regulations, ERISA, HIPAA, related federal regulations or regulatory compliance requirements Knowledge of group health insurance terminology and concepts Claims processing experience a plus Skill in using MS Excel, Word, Outlook and research databases. Excellent communication, customer service and problem-solving skills. Ability to research and interpret legislative and legal documents Ability and skill in business writing policies, procedures, forms, instructions and all forms of written communication including email communication Ability to be detail-oriented, critical thinking and deadline oriented
Education & Experience
High School Diploma or GED, some college preferred 3 years previous professional office/work experience 2 years previous health insurance industry or claims experience highly preferred Excellent Microsoft Office skills
This is an excellent opportunity to receive competitive pay and great benefits while working in a friendly and casual dress work environment. Should you meet the requirements as described and if you would like to work with dedicated co-workers, be part of a great team, and join a stable company, we would like to hear from you!
Note: All your information will be kept confidential according to EEO guidelines. We are an Equal Employment Opportunity Employer.
The Boon Group - 2 years ago