Role: Compliance Officer

Job Description 

• Identification and management of the TPA’s compliance risk. Role reports to Operations Compliance Manager 

Responsibilities:  

• Administration of an effective Compliance Program which meets State and Federal requirements.

• Establishes the framework and associated procedures for Regulatory Change Management and drives it to ensure that regulatory change is identified, correctly interpreted, and placed into the change process with the provision of technical advice to aid its implementation.

• Working with clients to gain consensus on requirements definition, project steps, budget and resources, and project deliverables.

• Advises on compliance laws, rules and standards, including keeping the Operations Compliance Manager informed on developments in the area and ensures a collaborative approach is adopted to implement necessary changes in the most effective way.

• Implementation of the Compliance Plan, such as the implementation and review of specific policies and procedures, compliance risk assessment, and compliance testing.

• Review compliance related policies, procedures and practice guidelines.

• Identification, measurement and assessment of compliance risk on continual basis including the development of Risk Indicators for Compliance.

• Regulatory reporting to ensure that all regulatory notification and reporting is accurate and submitted on time.  

Qualifications: 

• Must have minimum of 6 years of experience in the Insurance Business (including Healthcare) in North America geography 

• Must have minimum of 3 years of experience in the field of Regulatory Compliance.

• Candidate has to have very strong understanding of Individual and Group Insurance Principles including ethics, fraud and financial crime.

• Must demonstrate strong understanding of key federal and state requirements with respect to all products including health care.

• Familiarity with Legal Interpretation of Key Laws to ensure alignment of Policies to legal requirements.