Summary
 

Responsible for assessing major business opportunities and potential business partners corresponding to compliance issues. Manages and coordinates complaint resolutions, regulatory inquiries or investigations and reporting. Responsible for critical regulatory matters working closely with others to develop and implement solutions in the areas of sales, underwriting, claims, customer service, marketing, or product development. Communicates and consults with agent licensing or appointment function on any necessary action to monitor or address concerns. Work with partners as needed on all in-state and out-of-state corporate requirements and policy form filings as they relate to regulatory compliance in all operating states and the District of Columbia. Support SIU fraud efforts through monitoring and promoting best practices. Supervises complaint handling, advertising reviews, policy and form filings and other compliance related functions. Responsible for developing and maintaining positive and effective internal and external relationships to support the business and drive compliance efforts.

Description
 

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:

Required Education:

• Bachelor’s Degree in a job-related field.

Required Work Experience:

• 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).

Required Skills and Abilities:

• 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.

Required Software and Tools:

• Microsoft Office.

What we Prefer you to have:

• Extensive knowledge and understanding of insurance laws and regulatory requirements.
• Strong knowledge of Group insurance products and processes.
• Comprehensive knowledge of functional operations.
• Strong ability to develop working relationships internally and externally.
• Strong project management and leadership skills.
• Experience with RegEd or other database software.
• LOMA designations such as FLMI, ACS, AIRC, etc. or other relevant Industry designations.

What We can Do for You:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits 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
• Wellness program and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Employee Assistance
• Discounts to movies, theaters, zoos, theme parks and more

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications required proof of semester hours, please attach your transcript to your application.

Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.

 

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

Some states have required notifications. Here's more information. 

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, 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.