The Compliance Specialist is an active, direct contributor to the development, administration and monitoring of the Compliance Program to ensure Capital’s compliance with applicable regulatory and other compliance program requirements. The incumbent supports and/or administers compliance processes owned by the Compliance Department, engages directly with business areas and legal teams, and participates in internal and cross-functional projects that involve compliance matters. The Compliance Specialist also serves as a point of contact to respond to compliance inquires and assist in resolving compliance issues.

• Supports internal customers by assisting them to understand regulatory and other requirements, implement compliant solutions and establish adequate monitoring mechanisms.
• Receives, logs, researches, analyzes, and responds to compliance inquiries and concerns that are related to regulatory and other requirements and guidance, as well as other compliance issues.
• Administers the Incident Reporting and Corrective Action process to ensure that compliance issues are identified, addressed, and resolved on a timely basis, using an approach that prevents future reoccurrence of similar issues.
• Participates in projects or committees aimed at implementing operational, technological, and other changes to achieve or maintain compliance with regulatory and other requirements.
• Conducts oversight activities of First-tier, Downstream, and Related Entities (FDRs), Delegated Downstream Entities (DDEs) and/or CHIP subcontractors, as applicable.
• Develops, maintains, and oversees compliance monitoring activities and strategies.
• Provides support during internal and external audits, as appropriate, and monitors the completion of corrective action plans.
• Reviews, analyzes and evaluates regulations and guidance to determine its impact and affected business areas.
• Prepares, coordinates and/or submits required regulatory filings, attestations or reports.
• Develops and maintains internal departmental policies and procedures and provides recommendations to business areas in their development and implementation of their own policies and procedures.
• Administers or supports processes owned by the department such as Corporate Policy Administration, Conflict of Interest Disclosures, Compliance Training, Regulatory Intake, Compliance Monitoring and Exclusion Screening, among others.
• Performs other tasks as assigned by management, the Compliance Officer or the Chief Compliance Officer.

Skills:

• Strong analytical, critical thinking and problem-solving skills.
• Strong written and verbal communication skills with all levels.
• Attentive to detail and nuances.
• Proficient use of a variety of computer applications, i.e., Excel and PowerPoint.
• Commitment to delivering high quality work products.
• Commitment to ethics, integrity and compliance.
• Driven to learn, understand, and accomplish.
• Ability to effectively collaborate cross-functional at all levels.
• Ability to work independently, effectively handle changing priorities, and know when to request input from management.
• Ability to persuade and negotiate to resolve differences with skill and understanding.
• Ability to effectively manage multiple projects and/or tasks in a timely and efficient manner.
• Ability to discreetly handle highly confidential information and issues.
• Ability to review, understand, analyze, and apply laws and regulations to specific facts and situations, e.g. those impacting Medicare Advantage, Affordable Care Act and CHIP, as well as those impacting non-government programs, as applicable.

Knowledge:

• Knowledge of Compliance Program requirements.
• Knowledge of applicable regulatory standards and regulations (e.g., Medicare
• Advantage, Affordable Care Act, CHIP, as applicable).
• Broad knowledge of the health insurance industry, including knowledge of standards, policies, and business practices and procedures related to compliance.
• Familiar with internal and external audit procedures and processes.

Experience:

• 3 years' experience in health insurance compliance, auditing, healthcare or related field (Medicare Advantage, Affordable Care Act and/or CHIP, as applicable).
• Experience interacting with regulators preferred (CMS, PID, DHS, as applicable).
• Relevant audit and/or operational experience preferred.

Education and Certifications:

• High School degree or equivalent
• Bachelor’s degree preferred.

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
• The employee must be able to work over 40 hours per week.
• The employee must occasionally lift and/or move up to 5 pounds.

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.