Senior Regulatory Affairs & Compliance Analyst

Summary:

Accountabilities:

1. Follows and monitors legislative and regulatory developments impacting our products and operations by researching and analyzing industry practices. Provides advice on proposed legal and regulatory changes on our operations and products.

2. Analyzes complex state and federal legislations and regulations which impact multiple areas of the organization. Researches compliance impact and communicates new requirements.

3. Determines group implementation leaders needed to oversee implementation work groups responsible for the administrative and operational aspects of complying with the new laws and other requirements. Provides detailed instruction to implementation group leaders regarding specific action required to achieve and maintain compliance. Assists in the implementation process by direct involvement and participation in the work groups to provide compliance guidance. Coordinates with the internal audit function to validate compliance over time.

4. Develops and seeks regulatory approval for fully insured contract language and other related materials Ensures the timely filing and approval of new language. Initiates proactive negotiations with regulators to obtain approval and maintain product and operational standards.

5. Coordinates with production staff to ensure appropriate contract language is incorporated into products.

6. Serves as a primary educator by providing guidance on regulatory investigations and subscriber appeals. Responds to inquires by providing analysis and problem-solving skills involving new and existing statutory, regulatory, legal and other requirements relating to statutory and contractual eligibility and coverage requirements.

7. Creates and/or assists in the implementation of audit plans, self-assessments and other activities to monitor and track compliance.

8. Drafts various legal and corporate documents.

9. Other duties as assigned

Required Qualifications:

* Bachelors degree in business and a minimum of 5 years regulatory and compliance experience. In lieu of degree, must have at least 9 years regulatory and compliance experience.

* Well developed communication skills with ability to express complex concepts into simple terms and ability to write clear, concise and grammatically correct materials.

Preferred Qualifications:

* Operational auditing experience (not financial).

* Medicare and/or Minnesota Medicaid experience.

* Knowledge of the Medicare Marketing Guidelines and the Medicare material review process.

* Knowledge of health plan operations including claims, enrollment, sales and marketing, health services and membership.

* Knowledge of health insurance regulation at both federal and state levels.

* Experience in the development and implementation of corporate regulatory compliance and ethics programs.

BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V.BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.