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:

Develop and present compliance training. Research, resolve, and track suspected compliance/privacy issues and provides guidance to management and employees. Assist with/conducts various internal/external audits. Provide information on compliance activities to board of directors/executive management/other internal/external sources as needed. Conduct annual risk assessments, conflict of interest, and other reviews as mandated by government contracted oversight agencies.

What You'll Do

• Manage the developing, implementing, and monitoring of compliance programs, to include as applicable, Health Insurance Portability and Accountability Act (HIPPA) privacy, Gramm-Leach-Bliley Act (GLBA), National Committee on Quality Assurance (NCQA) confidentiality requirements, all government program requirements including internal control reviews, internal and external compliance audits, and investigation of compliance issues. Monitor, record, and tracks all potential and actual disclosures of PII and/or PHI as required by various privacy/security laws. Prepares and submits all reports of disclosures to the Prime Contractor or appropriate government agency. Maintain records on all incidents and provides routine and ad hoc reports to management, Prime Contractors or government agencies.

• Assist in developing, implementing, and presenting on-going compliance related training to employees including training in awareness and knowledge of HIPAA privacy. Administer annual certification of compliance statement and compliance awareness survey for government programs.

• Investigate, track, and follows-up on all compliance issues. Prepare response inquiries as applicable for government and regulatory agencies. Government programs to include monitoring and follow-up of all hot line reports and exit interviews.

• Prepare and provide information on division compliance activities as needed. Complete required reports.

• May assist in preparing needed documentation and obtaining regulatory approval for licensure and may assist in preparing and/or providing information for use in various proposals for retention of existing business or new business opportunities.

To Qualify for This Position, You’ll Need:

Required Education:

• Bachelor's in a job related field

Required Work Experience:

• 3 years healthcare/hospital management.

• 3 years claims analysis/adjudication procedures, trending, or patterns of practices. (may be concurrent)

Skills and Abilities:

• Conducts ongoing compliance audits

• Investigates compliance issues

• Prepares Audit Recommendations

• Receives inquiries from third parties

• Responds to requests for information

What We Prefer You Have:

• Medicare Experience

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.