Job Description:

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.

The Regulatory Performance Analyst II is a subject matter expert (SME) in assigned compliance area.  Responsible for communicating Federal and State regulatory requirements to operational areas within their SME purview and conducting follow up to assure implementation. Analyzes and clarifies guidance as required for the business area and obtains clarification of guidance as appropriate. Identifies possible compliance issues, assists with investigation and resolution, escalating issues when appropriate. Assists with monitoring to measure compliance with regulations and guidance, communicates findings to impacted business areas and completes follow up to assure resolution of the identified issues.

 Responsibilities:

·       Provide regulatory interpretation, analysis and make recommendations to management

·       Work proactively to ensure business areas falling within their purview are prepared for audits, aware of current guidance and can produce a compliant universe 

·       Review indicators and other monitoring tools impacting their SME area, spot trends and identify potential compliance issues, providing feedback to business areas and escalating as required

·       Effectively using the Corrective Action Plan policy and procedure to correctly and completely document identification and remediation of all compliance issues impacting their SME area

·       Coordinate with business area to review regulations, implement corrections if necessary and track completion

·       Coordinate with business area partners to ensure reported issues are updated weekly on the CMS Disclosed Issues Grid

·       Help ensure business areas within their SME purview are engaged and prepared to report results at all compliance committees and workgroups

·       Act as a liaison between CMS Regional Offices and Independence when needed

·       Conduct monthly Call Center Monitoring reviewing customer service calls and providing feedback as appropriate

·       Able to back up another SME area

·       Other duties as assigned

QUALIFICATIONS

·       Bachelor’s degree in related field or equivalent work experience.

·       Minimum of 3 years related work experience in managed care or health care.

·       Excellent organizational, verbal and written communication skills required.

·       Working knowledge of Microsoft Office products required.

·       Previous compliance experience is preferred. 

·       Knowledge of health insurance is an asset.

·       Knowledge of Federal and/or State regulations related to the health insurance industry is an asset.

Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania

Equal Employment Opportunity

Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. 

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