Regulatory Compliance Specialist

Regulatory Compliance Specialist

The Regulatory Compliance Specialist is responsible for ensuring compliance with all jurisdictional regulations within the designated department, mitigating potential legal and other company cost exposure. This position is solely responsible for recommending and helping implement process and internal policy changes based on state regulation changes. This position acts as an independent, positive and professional representative of our CorVel family, interacting with national and state officials, clients, claims, providers and all levels of internal management. May function as a member of the bill review department leadership team, the national network team, provider relations and / or specialized teams, ensuring optimum quality performance by providing regulatory guidance and assistance to achieve the organizational goals.

This is a remote role.

Essential Functions & Responsibilities :

• Provide technical and jurisdictional guidance to management, clients, external and internal claims staff along with their defense counsel regarding complex regulatory items
• Evaluates all upcoming regulatory changes, communicating to effected departments to enable system and policy / procedural updates where needed in a timely manner
• Acts as a functional resource in partnership with Manager for overall regulatory compliance of assigned department
• Responsible for internal and external compliance review and audits
• Travels to customer, claims and employee sites as needed to attend meetings, perform training and otherwise supports business need
• Provide and utilize broad based knowledge of the assigned State Workers' Compensation guidelines, Labor Codes and other applicable documents
• Effectively communicate regulatory requirements to the appropriate individuals; providing training as needed
• Independently interpret and apply various client network contracts to support medical bill review to include direct network and affiliate contract verbiage, carve-out and LOA details
• Displays working knowledge of assigned department functions; communicates those regulations to the appropriate individuals to maintain compliance with national and / or local jurisdictional guidelines
• Negotiate audits with state and national offices with the goal to have CorVel at 100% compliance
• Properly track and report assigned compliance outcomes and successes
• Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program ("IIPP")
• Requires regular and consistent attendance
• Additional projects and duties as assigned.

Knowledge & Skills :

Education & Experience :

Pay Range : $51,807 - $83,551

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors : federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w / Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.