Director, Contract Compliance

Summary

Description

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

This role will focus on pharmacy benefit compliance regarding state and federal requirements. In addition, this role will support internal oversight of the department regarding URAC and NCQA requirements. Responsible for assessing major business opportunities and potential business partners and corresponding to compliance issues. Manages and coordinates all in-state and out-of-state corporate and contractual requirements and policy form filings as they relate to regulatory compliance in all operating states and the District of Columbia. Manages policy/certificate issuance software. Supervises agent licensing and appointment functions, complaint handling, Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security, and Employment Retirement and Insurance Security Act (ERISA) compliance.

Logistics: BlueCross and BlueShield of South Carolina.

Location: This is a full-time position (Monday through Friday, 40 hours per week) that operates on a hybrid work schedule, to include three days onsite and two days work at home. This role is located at 4101 Percival Road in Columbia, SC 29229.

What You'll Do:

• Develops solutions and plans of action for major business opportunities. Assesses and evaluates potential business partners.

• Designs and implements Privacy and Security compliance programs. Assists management in developing policies and procedures consistent with federal and state requirements and implementing necessary changes. Directs the implementation of the Patriot Act compliance initiative.

• Ensures all claimants receiving claim checks have been screened against the list of Prohibited Persons published by the Office of Foreign Asset Control. Oversees Anti-Money Laundering initiative. Ensures that high-risk products and distribution channels receive an increased level of Anti-Money Laundering scrutiny.

• Directs the preparation and approval of all contract language for agency contracts, endorsements, certificates and booklets in all jurisdictions in which agency is authorized to do business. Coordinates the development of agency benefits with Senior Management and external personnel. Initiates revisions to existing and renewal contracts, certificates, and booklets in all operating jurisdictions to comply with changes in agency operations and to improve clarity and intent of the documents.

• Coordinates and directs the drafting of all policy and certificate language for the company’s product portfolio. Implements all policy and certificate revisions and coordinates the review with all appropriate areas. Distributes and disseminates changes in contracts to Senior Management and Directors of all business units.

• Directs the filing of all contract language with the Insurance Commissioners in all jurisdictions where agencies operate. Obtains approval of all agencies’ policies, certificates, applications, and actuarial information necessary to conduct the business of insurance. Gains admission into new states where the company wishes to do business, coordinating activities with Executive Management, Senior Staff, and the Legal Department as appropriate.
  
• Responsible for the policy and certificate issue system. Writes and oversees the writing of programming logic to ensure the correct language/benefits are issued depending on state of issuance, benefits requested type of policy, and line of business.

• Maintains advertising files in accordance with state advertising regulations.

• Directs Agent Licensing Department. Ensures all producers are appropriately licensed and appointed to represent agency and have current contracts including the requisite HIPAA Business Associate Agreement.

• Reviews incoming memoranda, bulletins, etc. from State Insurance Departments and federal government to determine company position and response.

To Qualify For This Position, You'll Need The Following:

• Bachelor's in a job-related field
  10 years claims, customer service, appeals, compliance administration or health insurance industry related experience.
• 3 years demonstrated leadership experience in a supervisory/management role or equivalent military experience in grade E4 or above (may be concurrent).
• Familiarity with audit or compliance procedures and regulations. Strong customer service orientation.
• Ability to effectively communicate both verbally and in writing to all levels throughout the organization. Excellent analytical, critical thinking and problem-solving capabilities.
• Ability to work in a highly changing environment; ability to persuade, negotiate or influence. Exercises confidentiality and discretion. Excellent presentation skills with a strong attention to detail. Ability to interpret and implement complex and ambiguous government rules.
• Microsoft Office.

We Prefer That You Have The Following:

• Experience with pharmacy benefit compliance.
• Knowledge of state and federal healthcare regulations.
• Familiarity with URAC or NCQA accreditation standards.
• Experience supporting compliance audits, reviews, or oversight activities.
  

Our Comprehensive Benefits Package Includes The Following:

We offer our employees great benefits and rewards. You will be eligible to participate in our benefits program the first of the month following 28 days of employment.  

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

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About Us

Welcome

Here’s Your Smart Career Move

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating.

We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Veterans Welcome!

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more.

Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson.

If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.

Join Us

If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!