Compliance Associate - Medicare/Medicaid

SUMMARY

Responsible for providing support, practical management and guidance to ensure the Company's operations are conducted in compliance with ethical business practices, Company policies and legal/regulatory requirements.  Advise business units and protect the Company's interests in all corporate, legal and regulatory matters.  

ESSENTIAL DUTIES AND RESPONSIBILITIES

Compliance Department Administration:

Manage carrier compliance investigations of alleged violations or rules, regulations, policies, procedures, and standard of conduct; including recording notifications, proper internal and external communication, and tracking to ensure timely responses.  Identify compliance trends through monitoring internal and external reporting and assisting in the development of compliance guidelines and tools.  Assist in call center oversight.

Coordinate, record, maintain and monitor compliance records, reports and analysis ensuring that all data records are complete and accurate to ensure compliance with applicable federal and state laws and regulations.

Assist with internal and external audits; and working with other departments on designated compliance matters.

Review agent-created advertisements, social media and websites; Directly provide guidance to internal and external parties.  Assist with submission of marketing materials to carriers for approval and regulatory approval if necessary.

Assist Compliance Officer with administering and improving the Company’s Compliance Program.

Assist with responses to alleged violations of rules, regulations, policies, procedures, and standards of conduct. 

Assist with proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required. 

Assist with statutory and regulatory monitoring and communication of updates throughout the Company and its downstream agents. 

Assist with the development and oversight of an effective compliance training program for the Company and its downstream agents, which includes appropriate training for new employees as well as ongoing training for all employees.

Assist with monitoring and coordinating the compliance activities of all business units, which includes tracking and reporting of key compliance metrics.

Assist with identifying potential areas of compliance vulnerability and risk; Assist with development and implementation of corrective action plans for resolution of problematic issues.

Special Projects:  Work collaboratively with fellow staff to advance the values and mission of Senior Market Sales by serving on relevant internal and external committees; Assists with special projects/assignments as requested by members of management.

Performs other duties as assigned by management. *


QUALIFICATIONS
EDUCATION / EXPERIENCE

Bachelor’s degree in business or a related field

One (1) or more years of compliance experience

Insurance industry or related field (financial services or marketing) experience

Carrier certification with MA/PDP

SKILLS

Working knowledge of federal, state and local laws, as well as industry regulations.

Working knowledge of insurance services industries.

Knowledge of the general industry procedures, practices and terminology.

Knowledge of systems management.

Knowledge of general office forms, processes and procedures.

Knowledge of program and project management including outcomes, quality assurance, and satisfaction measurement and interpretation.

Knowledge of supervisory techniques to accomplish instruction, motivation and training.

Skill to supervise, motivate and train.

Skill in working effectively with inbound and outbound callers/customers.

Skill in negotiating and problem solving to resolve internal and external conflicts.

Skill in the use of office equipment including computer, fax, printer, telephone system, etc.

Skill in the use of time management.

Skill in maintaining effective working relationships with all customers, employees and the general public.

Proficient computer skills (Microsoft/Word, Excel, PowerPoint, Adobe Acrobat, MS Outlook software preferred).

Ability to communicate effectively, both orally and in writing, in a constructive manner.

Ability to approach and communicate with a wide range of personalities in a professional and courteous manner. Ability to be patient under frustrating circumstances and demonstrate controlled emotional affect in difficult situations.

Ability to engage in effective interpersonal interaction, verbal communication and written communication.

Ability to maintain a high level of organization and attention to detail while remaining flexible and responsive when faced with multiple urgent requests.

Ability to read, write and communicate English effectively.

Ability to maintain all company policies, including all confidentiality and safety policies.

Ability to actively contribute to team effort.

Ability to work independently, exercise independent judgment, make and execute decisions.

Ability to develop and foster trusting relationships.

 Strong verbal and written proficiencies of the English language is required and bilingual (Spanish and English) preferred.

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