Summary
 

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. 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 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!

Description
 

Position Purpose:
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:

This position is expected to be a fully onsite position in Columbia, SC.

What You'll Do:

• Develop solutions and plans of action for major business opportunities. Assess and evaluates potential business partners.
• Design and implement Privacy and Security compliance programs. Assist management in developing policies and procedures consistent with federal and state requirements and implementing necessary changes. Direct the implementation of the Patriot Act compliance initiative. Ensure 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. Ensure that high-risk products and distribution channels receive an increased level of Anti-Money Laundering scrutiny.
• Direct 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. Coordinate the development of agency benefits with Senior Management and external personnel. Initiate 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. Coordinate and direct the drafting of all policy and certificate language for the company’s product portfolio. Implement all policy and certificate revisions and coordinate the review with all appropriate areas. Distribute and disseminate changes in contracts to Senior Management and Directors of all business units.
• Direct the filing of all contract language with the Insurance Commissioners in all jurisdictions where agencies operate. Obtain approval of all agencies’ policies, certificates, applications, and actuarial information necessary to conduct the business of insurance. Gain 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. Write 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.
• Maintain advertising files in accordance with state advertising regulations.
• Direct 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.
• Review 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:

• Bachelors 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 Have:

• Regulatory Filings and Compliance experience
• Experience with Contract Analysis, Contract Administration, Contract Negotiation, and Contract Research.
• Understanding of the DocuSign product.

Work Environment: 

• Typical office environment. Some travel may be required.

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.