Senior Compliance Specialist

Senior Compliance Specialist

Requirements

• 5 years of experience with government or compliance, privacy, or legal issues
• High School Diploma or equivalent
• Bachelor’s degree in legal studies, compliance, or other related field of study
• Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
• Intermediate PC proficiency
• Intermediate proficiency in spreadsheet, database, presentation and word processing software
• Proficient in legal research and understanding of legal terminology, and procedures
• Advanced knowledge of ethical, corporate or government compliance, or HIPAA Privacy issues
• Analytical skills to support independent and effective decisions
• Prioritize tasks and work with multiple priorities, sometimes under limited time constraints
• Perseverance in the face of resistance or setbacks
• Effective interpersonal skills and ability to maintain positive working relationship with others
• Verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts
• Ability to create and deliver employee education of complex government or corporate compliance, privacy and ethical issues in an understandable way
• Maintain confidentiality and privacy
• Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data
• Take appropriate risks using available data
• Build synergy with a diverse team in an ever-changing environment

Responsibilities

• Oversees BCBSAZ identification, tracking and evaluation of new and updated mandates to ensure compliance with all applicable requirements
• Manage regulatory reporting activities and submissions on behalf of AZ Blue to various organizations, including but not limited to the Arizona Department of Insurance and Financial Institutions, Arizona Corporate Commissions, and federal agencies
• Performs ethics, government compliance, corporate compliance, or privacy investigation, research and training to ensure that BCBSAZ complies with state and federal laws, as well as activities that promote an ethics culture within BCBSAZ
• Performs end-to-end research, preparation and submission of regulatory filings in compliance with legal, the Blue Cross Blue Shield Association, and regulatory requirements
• Work collaboratively with various internal partners to prepare and submit required reports, forms, and documents while ensuring accurate and timely regulatory report submissions
• Assess existing regulatory reporting processes and develop recommendations to improve efficiency and effectiveness
• Maintain document management system for audit and retention of the various regulatory reporting submissions
• Through critical analysis, identifies possible violations of laws, regulations, policies or fraudulent activities of employees, providers, subscribers, vendors and contractors by applying the appropriate legal, corporate or ethical policy
• Performs in-depth investigations for possible violations or fraudulent activity by researching, data gathering, interviewing, analyzing findings, developing corrective action plans and implementing those plans
• Apply data analytics techniques, to examine, interpret, and report results for leaders to make data-driven decisions
• Oversee the Governance, Risk and Controls (GRC) processes and tools, to ensure it is aligned with our organization’s strategic priorities and regulatory obligations
• Assist team in meeting project deadlines and schedules
• Mentors team members and trains new team members
• Assists management of Corporate Integrity as required on other projects / tasks
• Assigns, tracks and oversees government compliance work
• Research best practices and new government laws and regulations for government and corporate compliance, privacy, ethics programs and recommends modifications to programs based on BCBSAZ’s size, corporate culture and risk assessments
• Manages projects with multi-disciplinary teams
• Acquires and maintains an in-depth knowledge of legal requirements, current government or corporate compliance and ethics, industry practices
• Serves as subject matter expert
• Mentors and cross trains with other Compliance staff
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements
• Performs all other duties as assigned

Preferred Qualifications

• 7 years’ experience with compliance, privacy, government programs or legal issues in a healthcare industry
• Master’s degree in business or healthcare field of study
• Paralegal certificate
• Advanced compliance professional or legal training