Managing Dir, MA Comp Oversght

<strong>At Emergent Holdings, we&rsquo;re creating an innovative environment where our employees belong authentically, contribute meaningfully, and thrive intentionally &mdash; both personally and professionally.</strong>

Southfield, USA

Emergent Holdings

<h3><strong>Attention:</strong></h3> <p><strong>From Dec. 7, 2020 until Dec. 27, 2020, we will be undergoing a transition to a new recruitment technology platform. During that time, we will not be able to accept applications.</strong></p> <p><strong>We apologize for any inconvenience this may cause.</strong></p> <p><strong>We appreciate your interest in joining our team, and would love for you to come back on Dec. 27 to apply.</strong></p> <p><strong>Thank you!</strong></p> https://emergentholdingsinc.com/

keywords: summary,work environment,strategy,relations,performance,compliance,support,direction exercised,education & experience,knowledge,skills,collaboration

Senior Director

Competitive Compensation and Benefits Package

Overview: <br /> <p>This position is responsible for ensuring regulatory compliance for Medicare Advantage and Part D programs within Emerging Markets. This includes:</p> <ul> <li>Regulatory oversight of BCBSM and Advantasure and Covantage compliance programs</li> <li>Strategic assessment and determination related to regulatory compliance risk for Emerging Markets</li> <li>Establishment of an effective system of controls (processes/tools) for Emerging Markets compliance management<br /><br /><br /></li> </ul> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed both in the office and in the field with minimal hazards. Occasional travel may be required.</p>
Responsibilities: <br /> <ul> <li>Provides oversight for compliance programs with accountability and direct reporting to Senior Health Services Executive Vice President with a dotted line to the Advantasure and Covantage Presidents.</li> <li>Sets the strategic direction for program compliance</li> <li>Develops and articulates clear strategic direction and vision for compliance in alignment with BCBSM, Advantasure, and Covantage clients and COBX stakeholders.</li> <li>Delivers compliant operational processes to quickly detect, effectively manage, and easily remediate compliance issues through the establishment and maintenance of a functioning system of controls.</li> <li>Manages the BCBSM CMS regulatory relationship and maintains a strong and trusting relationship with regulators by demonstrating knowledge of requirements, urgency in addressing issues, willingness to partner on initiatives, and showing the appropriate level of respect and deference. Makes recommendations to Advantasure and Covantage clients on their regulatory relationship issues.</li> <li>Develops strategic compliance solutions to meet business needs</li> <li>Makes recommendations to balance regulatory compliance with business growth and operational effectiveness with regulatory compliance.</li> <li>Provides effective audit support and plan defense by understanding both compliance and plan operations and negotiating for best outcome.</li> <li>Delivers five-star performance in sales information accuracy, handling sales foreign language inquiries and sales TYY inquiries, and that beneficiaries are protected from predatory sales practices.&nbsp;</li> <li>Oversees the performance of sales staff, sales agents and delegated entities in accordance with CMS for successfully operating a Medicare Advantage and Part D plan, including secret shopping of sales events, investigating marketing complaints and monitoring of tele-sales activities.</li> <li>Manages a staff of 40+ compliance professionals with a multi-million-dollar compliance budget.</li> <li>Liaison to the Medicare Compliance Officer (BCBSM and all Advantasure and Covantage compliance officers) to ensure that risks are addressed, and corrective actions developed.</li> <li>Represents BCBSM in community and industry, programs, and conferences.</li> </ul> <p>&nbsp;</p> <p><strong>DIRECTION EXERCISED:</strong></p> <ul> <li>Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws.&nbsp;</li> <li>Responsibilities include but are not limited to effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.</li> </ul>
Requirements: <br /> <p><strong>EXPERIENCE:</strong></p> <ul> <li>Ten years of progressively more responsible experience in a health insurance compliance role or regulatory environment.&nbsp;</li> <li>Ten years of director-level experience.&nbsp;</li> <li>Medicare Advantage experience preferred.</li> </ul> <p><strong>&nbsp;</strong></p> <p><strong>EDUCATION:</strong></p> <ul> <li>Bachelor&rsquo;s degree required.</li> <li>Master&rsquo;s Degree in related field preferred.</li> </ul> <p>&nbsp;</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Recognized expert in Medicare Advantage and Part D requirements.</li> <li>Strong knowledge of Health Plan member requirements, particularly with government programs (Medicare, Medicaid).</li> <li>Specific knowledge of CMS regulations, the Medicare Managed Care Manual, Part C and D regulations, and operational areas such as enrollment, claims, and customer service.</li> <li>Clear understanding of compliance requirements for Medicare Advantage communications materials.</li> <li>Successful in managing communications development timeframes and quality.</li> <li>Knowledge in legal research and monitoring of federal and state regulatory laws and legislations.</li> <li>Knowledge of medical benefit design, marketing, and health care policy.&nbsp;</li> <li>Strong organizational, planning, analytical, and communication skills.</li> <li>Must demonstrate leadership ability and team-building skills to effectively supervise professional and non-professional staff and interact with all levels of management.</li> <li>Ability to work with and empower others on a collaborative basis to ensure success of unit team.</li> <li>Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques.</li> </ul>