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BASIC FUNCTION HCSC
is looking for a dynamic individual to join its Corporate Compliance team! This position is responsible for evaluating Government Program (Medicare and Medicaid) regulations, guidance and contracts, assessing the risk that those items present with respect to HCSC government contracts; may manage direct reports and provide oversight of the business' operational compliance with the requirements through multiple mechanisms such as review of reports, attendance at operational meetings, and targeted monitoring of areas of concern. This role ensures our organization adheres to federal/state/local laws, regulations, and contractual obligations and will develop policies, conduct monitoring, manage risk, and act as a liaison with regulatory agencies to prevent legal penalties. Will be working independently to identify risks and issues of noncompliance, develop strategies to mitigate and remediate those risks and issues and work with Corporate Compliance and business personnel, as well as all levels of HCSC management and governmental agencies in order to implement controls and processes and report on results.
NOTE:
this role is
TELECOMMUTE
; sponsorship will NOT be extended either now or in the future.
REQUIRED JOB QUALIFICATIONS
- + Bachelor's Degree and five (5) years' experience in healthcare compliance
- OR•nine (9) years' experience in health plan, regulatory compliance or risk management.
+ One year of leadership/supervisory experience. + Experience communicating and building relationships with internal business units and/or various external governmental agencies. + Strong critical thinking, risk assessment and mitigation. + Ability to influence processes to achieve results. + Excellent verbal and written communication skills. + Ability to work independently and be a self-starter. + Organizational, project management, analytical and decision-making skills. + PC proficiency to include MS Teams, Word, PowerPoint and Excel as well as Workday.
PREFERRED JOB QUALIFICATIONS
- + Government Programs Healthcare Compliance experience - equivalent experience will be considered. + Knowledge of Medicare Advantage-Part D or other regulatory experience. + Master's Degree. + Government programs operational experience.
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KEY ROLE FUNCTIONALITY
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- + Identify, review, analyze and understand contractual and regulatory requirements.
+ Evaluate Government regulations, guidance and contracts, and identify specific risks that they present to HCSC government contracts. + Responsible for performance of HCSC Office of Foreign Assets Control and Debarment process and management of staff performing the process. (Validation that individuals and entities with which HCSC does business are not precluded from participating in state or federally funded programs.) + Review Government Programs policies and procedures, workflows, training materials and other documentation for compliance with requirements. + Consult with the business and provide guidance as the business plans, implements and monitors its compliance with contractual and regulatory requirements. + Identify and follow up on compliance issues and track issues to resolution. + Provide accurate and complete documentation of reported information, risks, issues, status and results. + Work with the business to agree upon issues, root causes, remediation steps, deliverables, additional training and education, communications, internal controls, compliance reviews or modifications to processes and due dates. + Manage or oversee management of issue resolution process which may include, as appropriate, but is not limited to + identifying barriers to meeting due dates + identifying actions or escalations needed to address barriers + escalating failure to meet due dates + escalating barriers appropriately + recommending disciplinary actions or other appropriate means to hold business owners accountable for actions or lack of actions. + Validate that business remediation activities successfully addressed agreed-upon root causes, deliverables and remediation steps. + Manage or provide oversight of remediation including: identification of root cause(s), identification and stratification of risks, development and implementation of recommendations for processes that would result in their mitigation. + Oversee development of remediation plan with the business including setting agreed-upon actions, deliverables and due dates and track execution of the remediation plan. + Provide compliance consultation and guidance to business owners, which may include participating in regular meetings, working with management to identify and mitigate risks and coordinating responses to questions from regulators. + Communicate and lead by influence with internal and external stakeholders at all levels throughout HCSC to achieve effective outcomes. + Identify, design, and perform targeted monitoring and/or reviews to determine if HCSC is in compliance with the terms of specific government contracts, regulations, guidance and private contracts. Document results and communicate findings to the business. + Provide and manage input related to the Risk Assessment process in order to most effectively stratify the risks presented by government business. + Coordinate, facilitate and take notes at internal and external meetings, including meetings with regulators. Prepare and distribute materials to participants. + Manage activities of direct reports. + Review operational reports from the business, track and trend results and identify issues or risks of noncompliance. + Create summary reports for management on issues and risks of non-compliance. + Report on Compliance Program activities, effectiveness and status, including ad hoc and routine management reports. + Contribute to preparation of quarterly compliance reports to HCSC boards and committees.
- Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
Pay Transparency Statement:
- At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work.
From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
HCSC Employment Statement:
- We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
- Base Pay Range
- $92,700.00 - $167,500.00 Exact compensation may vary based on skills, experience, and location.
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- For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families.
As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only
- requests for accommodations in the application process
- will be returned.
All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.
