Compliance Specialist

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="https://bcbsm.taleo.net/careersection/2/jobsearch.ftl?lang=en" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

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Full-time

Competitive Compensation and Benefits Package

Overview: <p><span style="font-family: Arial; font-size: medium;"><em><strong>Department Summary</strong>: Responsible for compliance-related activities for Michigan contracts, joint venture contracts, and client services for&nbsp;<strong>Medicare Advantage business, Medicaid, and the Federal Employee Program</strong>, including analyzing, planning, and implementation of monitoring reviews. May provide support or input to compliance-related workgroups and guidance interpretation.</em>&nbsp;</span></p> <p><span style="font-family: Arial; font-size: medium;">Conduct compliance investigations and lead the execution of complex initiatives for Blue Cross Blue Shield of Michigan (BCBSM) and its subsidiaries. Support leadership in the design and implementation of compliance initiatives.</span></p>
Responsibilities: <ul> <li>Conduct comprehensive and complex regulatory analyses to include the review, summarization, and dissemination of compliance reports.</li> <li>Lead privacy investigations to evaluate associated business risks and provide recommendations to leadership to maintain compliance.</li> <li>Facilitate government audit requests and inquiries by establishing timelines and deliverables.</li> <li>Maintain knowledge of insurance industry standards and monitor the regulatory environment to identify business vulnerabilities, conduct risk assessments, and recommend process changes.</li> <li>Support management in the determination of resource allocation for key compliance initiatives.</li> <li>Prepare executive-level compliance reports and presentations.</li> <li>May lead or direct the work of other compliance team members.</li> </ul>
Requirements: <ul> <li>Bachelor&rsquo;s degree in related field is required. Master&rsquo;s degree in related field is preferred.</li> <li>A minimum of five (5) years of related experience is required.</li> <li>Previous experience with regulatory requirements is preferred.</li> <li>Previous leadership experience is preferred.</li> <li>Compliance Certification Board (CCB) certification(s) is preferred.</li> <li>Advanced proficiency using Microsoft Word, PowerPoint and Excel.</li> <li>Advanced written and verbal communication skills.</li> <li>Ability to analyze large quantities of detailed information with high levels of accuracy.</li> <li>Ability to facilitate resolution to high-impact and cross-functional problems.</li> <li>Advanced knowledge of process improvement tools and techniques to improve business processes.</li> <li>Ability to manage multiple priorities and projects of high complexity.</li> <li>Ability to travel up to 20% of the time both within and outside of Michigan.</li> </ul> <p>&nbsp;</p> <p><span style="font-family: Arial; font-size: medium;"><em><strong>DEPARTMENT REQUIREMENTS:</strong></em></span></p> <ul> <li> <div>Working knowledge of MetricStream.</div> </li> <li> <div>Experience with monitoring Medicare Advantage business areas and vendors for compliance.</div> </li> </ul>