Wellcove, CHCS Services is a company positioned for growth and excellence. It may not be an exciting time in the marketplace, so we aim to shake things up. We are looking at acquiring more companies and we have already begun to place a larger investment in technologies and tools for our associates and our customers.

Our story

We’ve been in business for over 30 years. We are a global company with delivery centers in the USA and INDIA. CHCS is an award-winning third-party insurance administrator (TPA) for senior health products. We are in the business of providing state-of-the-art administrative support services and customized care solutions to manage policies and claims. CHCS Supports some of the largest senior market insurance companies in the world. We process hundreds of thousands of claims every year, and our vast network of experienced registered nurses and healthcare professionals provide personalized care management services to policyholders.

The Future

Within the next 5 years, we seek to become THE leader in the TPA services marketplace! We know we’ll need to build an even stronger team to achieve this goal. We are ready to invest in the company and in you.

Investment in technologies: new call center technology is Five9s and continual refresh of systems.

Job Summary

The Compliance Analyst is responsible for performing various activities in support of compliance program initiatives, focusing on root cause analysis and reporting and monitoring.

Duties/Responsibilities:

1. In this pivotal role, the analyst will ensure meticulous compliance and facilitate seamless and effective root cause analysis across departments through trend analysis while operationalizing efficiency and minimizing disruptions.
2. Addressing and documenting receipts to resolve client complaints in a timely manner.
3. Partner with operations resources to ensure proper handling of complaints, investigating of complaints, and any required filings.
4. Work directly with clients to obtain additional information to ensure matters are handled in an objective and fair manner.
5. Identify and escalate complaints to senior management as necessary.
6. Identify and share innovative practices or process improvements.
7. Excellent presentation skills to deliver compliance-related tasks throughout the company (i.e. training programs)
8. Provide guidance and assistance in the identification, implementation, and maintenance of compliance policies, procedures, and Standards of Procedure for the department and across the enterprise.
9. Maintain professionalism with all client-facing and/or policyholders’ interactions.
10. Assist with managing relationships with clients and seek to solve concerns that can negatively impact on service delivery to policyholders.
11. Evaluate documentation for completeness and consistency and assign additional actions as necessary to close the complaint file.
12. Evaluate complaints for reporting requirements in accordance with client’s procedures and regulatory requirements.
13. Perform sampling of complaints to identify risk indicators.
14. Manage complaint workload to proactively address backload objectives and/ or decrease client’s reportable incidents.
15. Other Compliance or reporting requirements activities as needed.
16. Support management of departmental risk in partnership with Business Continuity and Information Security teams
17. Support vendor management program and vendor offboarding
18. Collaborates with cross-functional teams to align and achieve goals as needed.

Required Skills/Abilities:

1. Must possess effective written and verbal communication skills, be able to communicate effectively with internal and external stakeholders, and escalate matters as appropriate.
2. Proficiency in healthcare regulations and standards, including HIPAA and CMS regulations, and familiarity with state-specific regulations are required.
3. Strong understanding of healthcare data exchange standards
4. Ability to effectively manage and prioritize time, tasks, and projects.
5. Excellent problem-solving, analytical, and critical thinking skills
6. Detail-oriented with a high-level commitment to quality
7. Highly proficient in Excel (i.e. pivot tables, lookups, advanced formulas)
8. Strong PC/MAC skills; familiarity with Microsoft Office required.
9. Team player with excellent cross-functional collaboration skills to work with all levels of employees.
10. Ethical judgment and integrity

Education and Experience:

Required :

• An associate degree and two (2) years of directly related experience may substitute for a Bachelor’s degree.

** Preferred** :

• Experience with Third Party Administrators and healthcare
• Experience working with global teams.

Standard Company Requirements:

Collaborative team spirit

• Accountable and able to work remotely and independently.

• Able to pass background screening and drug tests pre and post-hire.

• Verification of high school, GED, and or college diploma upon request

• Timely responses from three professional references

• Able to provide a dedicated remote work location free from background noises, interruptions, and desk clutter.

• Able to provide an ongoing reliable internet connection and access to a smartphone.

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift up to 50 pounds at times.
• Must be able to access various departments of a given location.
• The physical demands described here are representative of those that an employee must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.
• While performing the duties of this job, the associate is frequently required to sit, use hands and fingers, handle or feel, and talk or hear. The employee is occasionally required to stand, walk, reach with hands and arms, climb or balance, and stoop, kneel, crouch, or crawl. The associate must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, and the ability to adjust focus. The associate must be able to present and speak simultaneously in meetings.