Manages staff responsible for the coordination of departmental/divisional operational activities and projects to ensure compliance with new and existing laws, regulations and requirements. Leads identification of departmental/divisional compliance risks and works with Corporate Compliance and other business areas as needed to develop and facilitate implementation of corrective action plans to mitigate risks. Utilizing significant expertise in the compliance field, provides consultative support to the department/division on changes, training and necessary communications.
Manages staff efforts to maintain departmental/divisional compliance with existing laws, regulations and requirements by leading cross functional projects that may impact a range of critical business processes aligned to key strategic initiatives.
• Takes actions, makes decisions, and shapes team or group priorities to reflect the organization’s Compliance Program.
• Leads the identification and analysis of complex regulatory compliance issues and business impacts, based on extensive knowledge of regulatory requirements and business operations.
• Lead departmental/divisional efforts in data gathering and analysis, data interpretation, process design, formulating conclusions and making recommendations for process improvements or changes that are required to maintain compliance in various areas.
• Coordinate needed risk assessments and/or audits and monitor department/divisional systems for compliance.
• Ensure appropriate implementation and/or corrective action is taken to address risks and issues identified in partnership with Corporate Compliance.
• Manages or coordinates complex, cross-functional projects to implement and ensure compliance with new laws and regulations.
• Lead the review of operational policies for compliance with state/federal laws and regulations and recommend process improvements/efficiencies as needed.
• Develop and implement training and other communications for department/division personnel.
• Analyze and assess departmental environment and compliance program and/or system needs. Recommend compliance programming and compliance initiatives in consultation with Corporate Compliance.
• Bachelor’s degree and at least 7 years work experience in health insurance in applicable division/business area, compliance or regulatory affairs that provides the candidate with exceptional knowledge of health care regulations and products.
• If no degree, at least 9 years experience as stated above.
• 3 years leadership experience, leading people, projects or programs is required.
• Direct project management experience with larger and more complex projects is required.
• Direct experience in consultative/advisory role is required.
• RN with NC license preferred.
• Certified Professional Coder preferred.
• Strong leadership skills, focused on coaching, mentoring and employee development.
• Ability to work effectively and partner with various business areas to solve business problems.
• Ability to think creatively and strategically while handling difficult, complex and ambiguous issues.
• Proven track record in effective and timely project management.
• Strong research and analytical skills
• Excellent oral/ written communication and presentation skills.
• Excellent organizational skills and the ability to adapt to changing business needs
• Strong PC and MS Office skills.
Internal Number: RQ0002907
About BlueCross BlueShield of North Carolina
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina. Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We are committed to better health and better health care in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.
Our company is a not-for-profit with headquarters in Durham and major operations in Winston-Salem and Fayetteville. In all we employ more than 4,500 North Carolinians and serve more than 3.7 million customers.
Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.