Job Summary
We are seeking an experienced Compliance Reviewer/Examiner to join our team! The Compliance Reviewer/Examiner is responsible for conducting onsite or desk audit compliance reviews under the Affordable Care Act regulation. They would also act as a Point of Contact and Owner of selected audit reviews based on rotations within the team. As a POC (PCO) they will be responsible for successful execution of the assigned compliance audit. The potential candidate should have good time management and prioritization skills in addition to a healthcare and audit background.
The ability to work under minimal supervision while delivering high-quality products on time is vital for this position. This position also requires the candidate to self- motivate and to conduct independent research for questions they may have. It is critical that they have an innate ability to learn new things and are open to constructive criticism.
The candidate will have good communication and personal skills, and the ability to work cohesively with the team and follow the lead of the Senior Examiners and Examiner-in-Charge. The candidate should have skills and expertise to assume ownership of the assigned review such as organizing work and assigning tasks within the team; ensuring that testing steps are completed on time and with the highest quality possible; providing regular updates; and escalating risks and issues to the Examiner-in-Charge and Program Director.
Responsibilities/Duties:
Develop and prioritize the review schedule and levels of effort to ensure timely completion of audits/reviews
Perform research and analysis of regulatory updates and guidance issued by CCIIO to Qualified Health Plan Issuers to ensure that testing is current and consistent with the NAIC Market Regulation Handbook and federal regulations
Perform research and analysis of data obtained for specific Qualified Health Plan Issuers
Document the research and analysis that has been completed and provide supporting documentation for Findings, specifically documenting how operational areas are not in compliance or where errors are identified
Use audit software (TeamMate) by completing all required sections and all work within the appropriate work areas
Prepare draft report and exhibits to summarize all Findings
Modify audit software to accurately reflect the report as issued after edits have been incorporated
Identify Findings requiring a Work Plan and monitor the completion of work plans by the Issuer
Modify report to accurately explain how the work plan was completed for final reports
Create and maintain project deliverables and reports to support contractual and regulatory compliance
Review and support the update of examination protocols when new regulations are released to ensure that they reflect the latest information
Education & Experience:
Bachelor's Degree plus 3 years of relevant experience or Master’s Degree and 1 years of relevant experience
Market Conduct Management (MCM) insurance designation
Accredited Insurance Examiner (AIE) and Certified Insurance Examiner a plus
TeamMate software experience desired
Specific Knowledge & Skills:
An extensive knowledge of Local, State, and Federal laws and regulations pertaining to the Affordable Care Act (ACA), health insurance, and/or healthcare services
Knowledge of health care laws and regulations (HIPAA, ERISA) a plus
Significant experience in the health insurance sector, specifically related to health care compliance, health care regulations, health care auditing, or fraud investigation
Strong understanding and commitment to professional auditing standards
High-level attention to detail
Excellent communication and writing skills in proper language according to the general rule
This is a remote position.