The Senior Compliance Specialist is responsible for supporting the Corporate Compliance Officer in administering the organization’s Commercial Compliance Program. This position is responsible for implementing Compliance Program strategies and initiatives at the direction of the Corporate Compliance Manager. As a senior team member, this position is expected to provide leadership to the team under the direction of the Corporate Compliance Manager.
Relationships: Provide support to the Corporate Compliance Manager and leadership to team under the direction of the Corporate Compliance Manager. Continuous contact with team members, and frequent contact with internal departments and personnel. Request and exchange information in a pleasant, professional manner. Work with internal departments and personnel to facilitate excellent services for PacificSource customers. Take a proactive approach to ensure quality service. Participate in regularly scheduled or ad hoc state regulatory agencies (including marketplace) stakeholder meetings regarding compliance issues.
Work Experience: Minimum 4-6 years experience in the healthcare or health insurance industry with specific experience in commercial compliance.
Language skills: Excellent written and verbal communication skills. Ability to clearly communicate with co-workers.
Mathematical Skills: Basic math skills required, including percentages, ratios, graphing and spreadsheet skills.
Reasoning Ability: Strong research, analysis, organizational, and interpretative skills. Requires ability to define and prioritize problems and manage workload without direct supervision.
Education, Certificates, Licenses, Registration: Bachelor’s degree in Business, Health Care Administration, Finance, Accounting or a related field. Masters Degree preferred.
Other Skills and Abilities: Ability to gain a thorough understanding of PacificSource Commercial Programs initiatives. Extensive knowledge of state (specifically Idaho, Montana, Oregon and Washington) laws and regulations affecting our business. Respond timely to regulatory inquiries. Maintain a working liaison with state regulatory agencies and CMS. Keep Commercial Programs informed of new regulatory developments. Maintain sufficient reference materials to adequately research legal issues. Participate as needed in the annual Qualified Health Issuer application process. Working knowledge of medical terminology. Ability to read and understand health contract and benefits language. Ability to work under time pressures, and to deal with emotional situations.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.