POSITION SUMMARY

The Analyst will provide leadership to the organization by implementing effective compliance processes and programs through the Compliance and Regulatory Affairs Department.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Resolves formal and informal Bureau of Insurance complaints, completing detailed research, developing innovative solutions, and working with relevant departments to ensure resolution.
  • Identifies and assists in resolution of complaint-related issues that may impact the wider Membership.
  • Tracks trends and makes recommendations for reducing abrasion.
  • Shares findings with operational areas.
  • Regularly communicates to ensure timely complaint resolution and to achieve most appropriate resolution.
• Tracks federal and state legislation and regulatory guidance through to operational implementation and ongoing monitoring of compliance.
  • Analyzes changes, creates and circulates summaries of relevant guidance to the organization.
  • Communicates legislative developments that may impact operations to applicable business owners through education sessions.
  • Develops and oversees implementation of integrated compliance updates.
• Works with product development and sales team to ensure compliance of existing and new products.
  • Research and answer product related compliance questions and works with outside counsel as necessary to understand compliance and legal risks.
• Reviews and approves marketing materials to ensure compliance.
• Responsible for managing external regulatory audits.
• Responsible for performing ongoing monitoring and auditing of identified risk areas.
• Complete external reporting to HHS, and the State of Maine, and other entities as required.
• Investigate and document reports of unauthorized disclosures of PHI.
• Assists departments in the development of associated operational policies and procedures to ensure compliance with applicable state and federal regulations.
• Assists with revising and writing corporate policies and procedures.
• Assists with the QHP/SBE filings and licensing activities.
• Manages compliance of operational areas with vendor management policies.
  • Act as the compliance liaison throughout the contract management lifecycle, from RFP to ongoing renewal of contracts.
• Assists with reviews of vendor performance and documents.
• Identifies opportunities for general compliance improvements and makes recommendations to Management.
• Assists in sponsoring and evaluating new tools and technology to enhance product and program performance or other internal efficiencies.
• Responsible for the management of the Enterprise Risk Management (ERM) plan and the Risk Register
• Responsible for ongoing updates to the ERM plan and Risk Register including at least bi-annual updates to the identified key risks and presentation of updates to the Audit Committee of the Board of Directors.
• Coordination and review of member benefit agreements and materials to ensure compliance.
• Manages and completes all regulatory licensing and filing activities in SERFF.

JOB SPECIFIC KEY COMPETENCIES (KSAs)

• Ability to take complex regulatory language and apply to health insurance operational processes.
• Strong writing skills
• Strong logical and analytical thinking ability
• Experience with regulatory research
• Ability to pay precise attention to detail.
• Strong verbal, written, interpersonal and public meeting communications skills.
• Ability to maintain production levels and quality goals with minimal direct supervision.
• Technical skills to complete documentation
• Proficiency with Microsoft Office (Word, Excel, PowerPoint)
• Proficiency with using web-based criteria preferred.
• Able to manage multiple priorities and deadlines in an expedient and decisive manner.
• Appreciation of cultural diversity and sensitivity towards target population.

DIVERSITY, EQUITY, AND INCLUSION STATEMENT

Community Health Options is committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion (DEI). Our human capital is the single most valuable asset we have. The collective sum of individual differences, life experiences, knowledge, inventiveness, innovation, self-expression, unique capabilities, and talent our employees invest in their work represents a significant part of not only our culture, but our reputation and achievement as well. Community Health Options DEI initiatives are applicable, but not limited to, our practices and policies on recruitment and selection; compensation and benefits; professional development, and training; promotions; transfers; social and recreational programs, and the ongoing development of a work environment built upon the premise of DEI, which encourages and enforces:

• Respectful, open communication and cooperation between all employees.
• Teamwork and participation, encouraging the representation of all groups and employee perspectives.
• Balanced approach to work culture through flexible schedules to accommodate varying needs of our people.
• Employer and employee contributions to the communities we serve to promote a greater understanding and respect for each other.