MediCard Phils., Inc. is one of the country's leading HMO and the only HMO founded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard. The competition is vast, and the benefits being offered by the competitors are tempting. However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality.
MediCard now boasts of more than half a million members and over 54,000 accredited doctors in over 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that provide services at par with those offered by hospitals minus the confinement.
MediCard is currently looking for assertive, dynamic and energetic individuals to fill up the following vacancy:
As a Sales and Business Quality Compliance Consultant, your position
objective will be to ensure our organization's adherence to sales and business compliance standards and regulations. Your primary focus will be on developing and implementing effective policies, processes, and controls to ensure compliance with ethical sales and business practices, consumer protection, and other industry-specific regulations. In this role, you will play a vital part in supporting compliance audits, monitoring sales activities, and providing guidance to Sales and Business Development teams to ensure ethical and compliant sales and business practices. You will also collaborate with other Business Units (BU) to develop and deliver training programs that promote a culture of compliance throughout the organization. By leveraging your expertise, you will help our organization maintain a strong reputation for compliance and integrity, while driving sustainable business growth.
Governance:
• Regularly review and assist in updating policies and standards related to SBQ Compliance, analytics on sales, agent recruitment data, products, distribution support activities, claim to identify non-compliance issues and monitor the investigation to address the issues.
• Assist the Compliance Officer in providing oversight to the complaints and investigation status by obtaining reports of all complaints and investigation cases and ensure that significant concerns are properly escalated and addressed.
• Conduct Gap Analysis of new and amended regulations, advisories, etc., and take necessary actions to address identified gaps.
• Stay updated with the latest developments in the environment, legal and regulatory landscape, and business trends to identify emerging risks and align them with SBQ Compliance initiatives.
• Identify opportunities to align strategic and tactical initiatives of the organization with laws, regulations, and Group-mandated policies to enhance the organization's value.
• Timely cascade of any material and relevant regulations to appropriate stakeholders.
• Provide compliance-focused advisory for all channels (agency and partnership distribution) in matters essential in strengthening the following 1st line functions: Predictive Modelling, welcome calls, mystery shopping, Early Warning System, etc.
• Assist in the implementation of the Anti-Fraud Policy and other related standards
Reporting:
• SBQ Compliance-related report submissions within turnaround time (TAT).
• Develop, review, and maintain key risk indicators applicable to SBQ Compliance
• Coordinate all communications mandated for SBQ Compliance.
Expert Advice:
• Support organizational priorities by ensuring timely completion of requested SBQ Compliance-related activities within the defined TAT.
• Provide expert advice as a Subject Matter Expert (SME) to Business Units (BUs) and senior management members regarding any concerns related to SBQ Compliance.
• Support the Risk and Compliance Department in performing product compliance activities, such as, but not limited to:
o Product design review
o Product risk assessment
o Sales and marketing materials review (Policy contract, sales illustrations,
brochures, training materials, etc.)
Assurance:
• Support in defining and executing risk-based compliance testing in relation to SBQ related regulations (and other group-mandated assurance activities)
• Provide assistance in both internal and external regulatory audits, ensuring compliance with applicable regulations and best practices.
Transformation:
• Provide expert support as a Subject Matter Expert (SME) in driving the operational transformation of SBQ Compliance initiatives.
• Support the development & deployment of Early Detection Analytical Tools for SBQ compliance misconduct.
Education and Training:
• Assist in the development of comprehensive training modules related to SQB Compliance, ensuring that they are up-to-date and effective.
• Conduct trainings within the organization to educate employees on SBQ Compliance.
• Collaborate in the creation and dissemination of advisories that provide guidance on identifying and complying with SBQ-related regulatory requirements.
• Attend relevant trainings to stay updated on the latest developments and best practices in SBQ Compliance.
Risk Support:
• Provide support in identifying and addressing operational, financial, and regulatory compliance risks associated with SBQ compliance.
You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.