Healthcare Compliance Specialist

JOB TITLE : Healthcare Compliance Specialist

PAY RATE : $57,000 to $75,000 DOE.

LOCATION : Hybrid (2-3 days) in Naperville, IL

About Avenica

Avenica is a career-launching platform that uses data science, behavioral psychology, and performance coaching to unleash human potential and launch careers.

By getting to know candidates beyond a resume and uncovering individual potential, we propel careers across the U.S. At Avenica, we put candidates first by advocating for them through the application and interview process.

Learn more about Avenica and how we can support your job search at www.avenica.com.

OVERVIEW OF POSITION : The Compliance Specialist is responsible for creating and filing healthcare insurance policies as well as ensuring that our client and its subsidiaries remain in compliance with state and federal laws, regulations, and guidelines.

DUTIES & RESPONSIBILITIES :

• Insurance Product Filing
• Review and edit insurance policies, certificates, and schedules, to ensure compliance with all state and federal regulatory requirements.
• Complete SERFF / HIOS rate and form filings, including QHP filings, according to state and federal standards and handling of all state objections to filings.
• Research and document SERFF filing procedures to keep informed of any changes.
• Maintain an accurate database regarding current status of filings.
• Ability to work with State DOI officials and Exchange officials, as necessary, to resolve issues.
• Regulatory and Healthcare Compliance
• Research federal and state laws and regulations.
• File TPA, SOS, and other annual license applications and renewals timely.
• Support the implementation and monitoring of the compliance program.
• Provide support and guidance to internal staff regarding compliance with laws and regulations.
• Assist with the development of educational materials on compliance topics for internal staff.
• Assist with the development of policies and procedures to ensure compliance with laws and regulations.
• Supports the Compliance Officer in investigating, reviewing, and tracking incidents involving Fraud, Privacy, and other non-compliance.
• Assists with Security Questionnaires, cybersecurity testing and training, and annual security audits.
• Assists the Compliance Officer with annual DDPA audits.
• Assists with responding to subpoenas, record requests, subrogations, and regulatory complaints.
• Perform other job-related duties as assigned.
• Maintain regular and punctual attendance.
• Access EPHI following the current guidelines as established at the company-wide and department levels.

EXPERIENCE & QUALIFICATIONS :

• 4-year college degree (or equivalent work experience)
• 5 years of experience with SERFF / HIOS filings for products both On-Exchange and Off-Exchange
• Experience in compliance, preferably within an insurance company
• Knowledge of state and federal requirements (e.g., required forms) related to product, rate and form filings
• Experience with legal research, technical, and business writing
• Knowledge of accident and health insurance
• Detail-oriented with excellent organizational and analytical skills
• Advanced skills in Microsoft Office applications

PREFERRED QUALIFICATIONS :

• Experience with healthcare privacy and security
• Experience with cybersecurity testing and training
• Experience with incident response and investigations for compliance, privacy, fraud, and / or security
• Experience with a Medicare compliance program
• Audit / Monitoring experience
• This position is based in our client's Naperville, Illinois office with flexibility to work from home as described in the Workplace Flexibility policy.

Our Process :

Upon completing the application, you will be prompted to complete our HAALO assessment. HAALO is simply a way for us to understand your preferences, behaviors, and work styles.

The assessment is a required step to complete this application.

Avenica is committed to providing equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and / or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law.

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