Compliance Manager

Compliance & Audit Park Ridge, Illinois Opportunities available throughout U.S.


Description

Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Position can be located in Park Ridge, IL (Preferred) or Remote within the U.S.

Company Overview

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina.  In addition, Clear Spring Health sponsors Medicare Prescription Drug plans in 42 states.

Job Summary 

This position is responsible for directing efforts ensuring compliance with federal and state regulatory and contractual obligations in the Medicare Advantage and Prescription Drug Plan markets.  Responsible for the strategic development and the implementation of the system of controls to monitor and oversee the performance of operations and other business units in accordance with state and federal requirements and other best practice and performance requirements.  Responsible for identifying potential areas of non-compliance by conducting investigations and / or performing compliance reviews and performing risk assessments.  Provides advice and guidance to operational areas regarding proper policies and procedures.  Additionally, this position will collaborate with internal and external business partners to provide guidance and recommendations around the development, maintenance and enhancements of compliance for products and services.

Main Accountabilities

  • Provide proactive monitoring and testing of business areas to ensure the identification of compliance risks
  • Work directly with business owners to facilitate remediation of compliance issues
  • Provide guidance to business owners on the development and maintenance of required policies and procedures.
  • Manage intake, review, summarization and dissemination of CMS guidance, including HPMS memo management.
  • Provide follow up and closure of HPMS memos, including obtaining evidence of compliant business operationalization.
  • Develop and maintain dashboard reporting on HPMS memo management and Policy and Procedure implementation and review process.
  • Manages compliance review of member materials assignment of material IDs in accordance with CMS guidance, uploading to HPMS, company websites as required, and tracking of member material status.
  • Work directly with Finance and Actuarial on the development and uploading of bids.
  • Preforms/tracks OIG/GSA checks.
  • Distributes/tracks new hire and annual compliance/FWA trainings.
  • Preforms additional compliance duties as needed

Qualifications

  • BA/BS Degree preferred or relevant work experience.
  • 5 yrs. experience with Medicare Advantage/Prescription Drug Plan compliance
  • Strong organizational and writing skills.
  • Strong communication skills.
  • Ability to read and interpret CMS guidance and regulations.
  • Strong work ethic and ability to foster working relationships throughout the organization at all levels required.